Raychel Lorenz
Week 1 in Miller

Monday:
This morning at 8:30 a.m. the hospital staff welcomed us with a breakfast and meet-and-greet.  It was a great opportunity for us to meet the staff. One of the main discussion topics at breakfast was the Miller High School graduation that took place yesterday. I enjoyed how everyone seemed to know all of the graduates and their families. After breakfast we got a tour of the clinic, hospital, and assisted living facility. I was very impressed with the entire facility, which was recently renovated. After the tour, I went to the clinic and immediately began seeing patients with Dr. Hopkins and Dr. Turner. It was refreshing to see how both providers seemed to personally know their patients and were very familiar with their past medical histories. My favorite part of the day was getting to visit with the patients. Each patient I spoke with made a point of personally welcoming me to the community.

After my day at the clinic, my partner in crime for the next four weeks, Leah, picked me up to give me a tour of the Miller community. Leah is a pharmacy student participating in the REHPS program with me. She grew up in Miller and knows the ins and outs of the community. We ended the tour at Dairy Queen before we called it a night. Thanks for a great first day Miller! I am so excited to see what this experience has in store!

Tuesday:
Today I met Karen, a nurse practitioner at the clinic. I enjoyed talking to Karen about working as an advanced practice provider in a rural community. She was a great resource to talk to on how to balance work and family, as she is a mother of three young children. We started the day by traveling to the Highmore nursing home to round on patients. We continued our nursing home rounds at the Miller nursing home. Many of the patients had lived in Miller for their entire lives and were extremely proud of their community. During lunch I attended a meeting with some of the medical staff and administration of the clinic. Various topics were discussed. I gained good insight of the accomplishments and struggles of a rural clinic. I ended my day by seeing patients with Dr. Schroeder at the clinic. He has practiced in the Miller community for over thirty years. I enjoyed hearing his stories on how the clinic and community have changed and developed through the years.

After clinic hours, I decided to use the hospital’s wellness center. It is a new fitness center that is also open to the community. It is a great facility with cardio and weight machines, free weights, and mats. On my way back to my room from working out, I was pulled aside by a nurse in the emergency department. She told me the ambulance was on the way and asked if I would like to observe in the emergency room. I stayed and worked with Shelly, a nurse practitioner at the clinic. I truly enjoyed working in the fast paced ER. We ended up admitting the patient to the hospital. I am excited to see the complete continuation of the patient’s care from the ER, inpatient setting, and eventually back to the outpatient clinic. The nurses told me they would call me for any more interesting emergency department cases while I am here. I am staying in a room at the connected assistant living center and told them I would love to run over for any cases! Thank you for such a great day, Miller!

Wednesday:
Leah and I started our day working with Dr. Werth, a general surgeon from Aberdeen. We watched colonoscopies and an upper endoscopy. Dr. Werth and the nurses helped explain the procedures and point out various anatomical structures. I really enjoyed watching the procedures. Cheri from the REPHS program took us out to lunch at a local restaurant. Leah suggested the southwest chicken wrap and it was delicious! It was great to speak with Cheri and catch up on what is happening with the REHPS program. After lunch we went on a home nurse visit to a community members house. The program is designed to help educate patients on their conditions, make sure they are taking the correct medications, and are living in a safe environment. I think it is a great program that coordinates the patient’s care and keeps them from having to be readmitted to the hospital.

Once again, I was amazed at how close-knit the Miller community is. Each patient I spoke with today took great pride in their community. Thanks Miller!

Thursday:
L
eah and I began our day by working with the radiology technicians. They were very busy today because a truck came to the hospital so patients could receive mammograms and DEXA scans too look for osteoporosis. I think that is such a great resource for the Miller community. Many of the women may not receive valuable screening procedures if that resource did not come directly to their community. On top of that, the radiology technicians performed CT scans and X-rays all day. I observed a CT scan that was looking for a kidney stone. The technicians were extremely informative and took a lot of pride in their work. I spent the rest of the day with Karen at the clinic. I really enjoyed working with her to perform physical exams and develop treatment plans. She really pushed me to come up with a diagnosis and plan of care independently. I appreciated such a wonderful clinical opportunity. In the afternoon I helped Leah with her pharmacy project. We took inventory of the pharmacy. It was a great opportunity for me to review all of the medications. It was also interesting to physically see all of the pharmacological agents that I have only read about. Leah was also a great source to have right there when I was not sure on what a certain drug was used for!

Once the clinic day had come to an end, Leah and I decided to enjoy the beautiful weather by going on a walk. We walked down by the local park and playground. We then took advantage of the wellness center at the hospital. As we finished our workout, we realized that a patient had arrived to the emergency room. Leah and I were able to perform a history and physical exam and observe an x-ray. When Karen arrived, we discussed a treatment plan. I am so excited to be receiving such a great rotational experience. Thank you, Miller!

Friday:
I spent my Friday in the clinic with Dr. Hopkins. It was a busy clinic day because everyone wanted to be seen before the long Memorial Day weekend. I got to see a wide variety of cases, from complications of hypertension to post-operative abdominal pain. One of the most interesting cases of the day was a patient who fractured his ulna and radius. It was very interesting to look at the x-ray and watch the fracture be placed in a splint. I also spent a lot of time up at the nurses’ station and was able to observe all of the tasks they have to complete. I appreciate how hard they were working in order to room patients, administer vaccinations, schedule referrals, and the list goes on and on! Because the clinic was so busy, we treated ourselves to order sweet Thai chili boneless wings from the Hi Lite restaurant. It was delicious. Thank you for such a wonderful first week, Miller!

Week 2

The clinic and hospital were rather quite on Monday due to the Memorial Day holiday. I spent my day on call with Karen, a nurse practitioner at the clinic. We were responsible for any patients that came into the emergency department. I really enjoyed my past emergency medicine clinical rotation, so I was excited for this experience. We had two ER visits. I have a lot of respect for the medical staff that works so independently in a rural environment. The ER does not have specialists readily available unlike more urban areas. The staff explained to me how they use telemedicine in the ER. They are able to call an ER physician and speak to him on the television if they have a case that is in need of extra assistance and specialization. What a valuable resource for rural emergency departments!

On Tuesday I started my day by rounding with Dr. Schroeder at the hospital. He was on call all weekend and was familiar with the inpatient population. While rounding, he explained some of the insurance and billing processes that take place in the hospital. Insurance is a very important part of medicine that not many providers realize they will have to deal with when they enter the medical field. After we rounded on patients in the hospital, we had a very busy day in the clinic. I helped Dr. Schroeder admit two patients to the hospital. The nurses explained how to write admission orders.  There are many details that are required to admit a patient. After clinic, I took advantage of the beautiful weather and went on a long walk through the community and by the park. I have only been in Miller for a week and already had familiar faces waving at me on my walk. I truly enjoy living in such a welcoming and friendly community.

This week Lea and I ventured to Aberdeen to be trained on a project we are going to complete during the REHPS program. We learned a lot about public health and the steps that need to be taken in order to gather data, identify needs within the community, and implement change. I really respect all of the work that public health officials do in order to make our communities a healthier place.  For our project, we are going to meet with various members in the Miller community. We will talk to them and complete surveys. The goal of the project is to determine if there are public health needs within the community, whether it be access to wellness centers or to healthy school lunches. I am excited for the opportunity to meet members of the Miller community outside of the healthcare system. It was also great to see other REHPS students today and hear what they have been doing within their communities!

I also got the opportunity to go to Miller Rexall Drug with Lea. The staff was very friendly and willing to answer all of my questions. The pharmacist explained how they work closely with providers to make sure patients are receiving the correct medication and dose. I really appreciate how great of a resource pharmacists are for answering patient questions on doses, side effects, and drug interactions. Lea and I worked together on Medication Therapy Management. It is a relatively new process for pharmacists. Lea and I went through a patient’s medications and their health indications. The program flagged any possible interactions or adverse effects that the medications could have on a patient’s health. For example, if a medication would worsen a patient’s heart failure. If there is an issue with a medication regimen, the pharmacist may contact the prescribing provider. The final step is to survey the patient on their medication compliance and answer any questions they may have. I think it is a great opportunity for health professionals to double check a patient’s treatment plan to provide the best care possible!

Lea and I ended our week by traveling with the respiratory therapists for home visits. Unfortunately, we had to cancel two of our visits out of town due to the rain. The patients called and said we may get stuck on the muddy roads. At one home visit, we helped a patient and the caretaker understand their new respiratory equipment. The respiratory therapists spent over an hour working with the patient and the caretaker. With trial and error, they were able to change the settings of the machines so the patient felt comfortable using them. They also provided instruction on how to use the equipment, along with other resources that would be available for them. It was such a positive experience to see the therapists make such a big difference. You could tell how thankful they were for the help, as they were feeling overwhelmed with all of the new equipment. The caretaker mentioned how it would have been difficult to pack everything up to travel to Miller. By going to the patient’s home, we were able to find a solution to the problem with no inconvenience. I truly enjoyed this experience and realized the importance of home health visits.

I want to thank all of the Miller staff for being so welcoming. Everyone is willing to have students and teach. I appreciate how the nurses always think to call me if an interesting case comes into the ER. I could not ask for a better experience so far. Thanks for such a wonderful week, Miller!

Week 3
On Monday Lea invited me to dinner at her family’s house in Miller. Lea and her mother were making a traditional German dish called cheese buttons. I love trying new foods and was excited to help make one of her family’s favorite meals! We started by making a mixture of cottage cheese, egg, ground pepper, and onion. We then made homemade bread dough. We stuffed the cheese mixture in the bread dough and fried it to perfection. The dish was delicious and I highly recommend it! After dinner Lea and I took her dogs for a walk. Lea’s mom also helped us take pictures by the Miller welcome sign. It was great to spend time with Lea’s family on such a beautiful summer night!

Throughout the week I spent time at the clinic with Karen, a nurse practitioner. We saw a wide variety of patient cases. Since I have been here for a few weeks, I have seen some patients multiple times. It has been nice to see some familiar faces and follow a patient through their treatment plan. We also had the opportunity to watch an online lecture on farm emergencies. It opened my eyes to the vast amount of emergency situations I would have to be able to care for in a rural community. Throughout the week I enjoyed performing some hands-on procedures, such as suturing.  I am so fortunate to have preceptors in the clinic that let me be so involved with their patient’s care. I have had a wonderful learning experience!

I spent some time with the laboratory technicians in the lab. They took the time to explain all of the technology that they use. It was really interesting to see all of the work that goes into the laboratory tests that providers order. I did not realize that there were so many different machines to run labs. It was also a great opportunity to learn exactly how long the different lab results take to get back. That is definitely something I will have to take into consideration as a provider. The laboratory technicians were so knowledgeable about all of the tests. They also have a great relationship with their patient population. They see many of their patients weekly for various lab draws and have developed relationships with them. It is a very hands-on and fascinating field that I was excited to learn more about!

Leah and I spent time this week working in the hospital pharmacy. We went through all of the medications and checked their expiration dates. I felt like we learned a lot by quizzing each other on trade names, generic names, and side effects. It was a long process but we were happy to help the hospital and learn about medications along the way!

We also spent time reaching out to Miller community members for our REHPS project. The project focuses on finding any gaps in public health and healthy living within the Miller community. We surveyed the Miller School District superintendent. He was very knowledgeable about programs available in the Miller community and within the school district. We also talked to a city council member. Everyone was very willing to take the time to answer our questions. They were also excited about seeing our finalized data. Through our interview, I have realized how dedicated the community members are to Miller. They truly want to make Miller a better place, and are open to any ideas that Lea and I may have. I hope that in the future I am able to be involved in my community. As a healthcare professional, I want to increase awareness of chronic disease and healthy living. I have gotten some great ideas on how to do so in the future by reaching out to the Miller community members, such as organizing farmers markets and community fun runs!

The weather has been so beautiful this week that Lea and I could not help but spend time outside in the evenings. On Thursday night we went to her brother’s softball game in Orient. Orient is about 30 miles north of Miller. Unfortunately our team did not win, but we enjoyed the beautiful weather and my favorite concession food of all time, tacos in a bag. On Friday night we decided to hit the golf course. Miller has a busy and beautiful golf course that holds golf league and tournaments. I was really excited to check it out! Lea and I are by no means golf pros, but we had a great time! Luckily Lea’s brother was there to help give us some instruction!

During the weekend I was on call with Dr. Hopkins. Every morning we rounded on the hospital patient. We were also called in on any emergency room patients. I really enjoyed my on call experience. I think it is important for me to have experience rounding on patients and thinking quickly in the ER.

Thank you for such a wonderful week, Miller!

Week 4
I can’t believe this is the last time I will be writing about my Miller experience. The past four weeks have flown by! Lea and I started our week by interviewing Travis Anderberg for our REHPS project. He is the owner of the Miller Rexall pharmacy and served as our workplace representative. He is extremely knowledgeable in his field of pharmacy and is always so willing to teach. In the pharmacy there is a traditional soda fountain. Lea and I hope to have an ice cream treat before our experience is over!

Lea and I used all of the information from our REHPS project we have collected to write a summery. We plan on sharing the information with the members of the community we interviewed. Hopefully the Miller community will be able to utilize the public health data. We also made a power point on our experience in Miller. We enjoyed reminiscing over the past four weeks. Cheri brought treats and a staff from the hospital and clinic came to see our presentation. I enjoyed sharing our experiences within the different hospital departments. We could not thank the staff enough for being so welcoming and willing to teach. While talking about our experiences, I realized how passionate the staff is about rural healthcare. I believe the REHPS program is a great opportunity to expose future healthcare professionals on the benefits of practicing in a rural community.

We also participated in some great outreach experiences this week. We went with Jodie, a registered nurse and patient care coordinator, on a nursing home visit. The patient was recently hospitalized with a chronic illness. We went to the patient’s home and taught them about their condition. We provided a binder with information, including important health warning signs. We made sure they were taking the correct medication and checked their vital signs. We also went with Kim, a respiratory therapist, to the nearby colony. We delivered a piece of equipment to a patient’s home. I was very excited for the opportunity to learn more about the colony. Lea and I were welcomed back and actually did a tour on Friday afternoon. Everyone was so pleasant, and it was a fascinating experience! I enjoyed learning about a different culture.

Through the REHPS program, I have learned a lot about home medical visits. The visits seem very important to the patients. They really appreciate when the healthcare provider comes to their home. It is important for the patient to feel confident in their healthcare, and know how to carry out their healthcare independently. The families also seem very grateful for the in home instruction. When a family member is ill, it is difficult to take in all of the information at the hospital or clinic. I think reiterating this information in a comfortable environment is very effective!

I had the opportunity to observe a cardiac rehabilitation session with Rita, a registered nurse. I thought it was very beneficial, because I had worked with many patients who attended cardiac rehab but did not know what they did during these sessions. I think it is a great way to help introduce exercise into a patient’s lifestyle. When a patient’s rehab sessions are complete, they are encouraged to continue exercises at the connected wellness center.

Lea and I also observed cataract surgeries. I was able to look through a microscope that had the same view as the surgeon during the procedure. The procedures had no blood loss, lasted about 10 minutes, and the patients were able to walk out of the hospital that same day! I was truly amazed by the procedure and grateful for the opportunity.

I continued to spend some time in the clinic, emergency department, and hospital this week with the providers. I also had the opportunity to travel to the Highmore nursing home with Dr. Hopkins. I have enjoyed forming relationships with the staff and patients. I could have not asked for a better clinical rotation. The staff was very willing to teach and provided great hands-on experience. I want to thank everyone that I had the opportunity to meet and work with.  I learned so much about rural healthcare and the importance of interdisciplinary medicine. I can’t wait to utilize my new skills and knowledge in my future career!

Thanks Miller!