Week 1 Custer, South Dakota
Tuesday, June 10th. Ashley and I arrived to Custer to stay at the long-term care facility Wedgewood. We were both a little apprehensive when we got the email stating we would be at the LTC facility, but…. Once we got here holy smokes! Wow it is beautiful. We each had an apartment style room with a private bathroom and the dining area has big open windows, which give a picturesque view of the valley and mountains surrounding Custer. Plus, our roommates are just great! We are looking forward to all the bingo and crochet lessons.
Wednesday, June 11th- Today was our first day at the hospital. We worked with two family practice physicians within the hospital Dr. Waddell and Dr. Falkenburg. The nurses and physicians are all great. We saw a wide variety of patients. I think it is impressive how much the providers need to know to promote the health of their patients. I am sure working as a provider in a small town you must learn something new every day. We also floated up to the hospital rooms and ER throughout the day. Dr. Falkenburg allowed me to stay overnight on call with her at the hospital. She had me see each ER patient before her so I could practice what it would like to be a provider. It was a little rough waking up in the middle of the night and critically think, but very good practice.
Thursday, June 12th. Well it was easy to get to work in the morning since I was already at the hospital. We started clinic after going out to breakfast with Dr. Falkenburg at the bakery. I absolutely knew we were in a small town when the doc realized she had forgotten her wallet and asked the waitress if she could just pay her later! I love it. These people know each other so well they are like family.
We saw such a variety of patients, some with hematologic disorders that in a larger town would be managed by a specialist. These rural practitioners are really on top of their game. Every day is such a variety of doing procedures (splinter removal, sutures), well baby exams, and even helping care for people at the end of life. Every patient that comes in to see Dr. Falkenburg is treated following scientific evidence and guidelines, but also with this spiritual component that is strong in individuals who live in the Black Hills. She is quick to suggest meditation, yoga, self talk, and other therapies that help individuals in ways beyond traditional medicine. She is a great person to learn from.
Friday, June 13th- Today we rotated with Dr. Brown who is another family practice doctor in Custer. She does the walk in clinic so she was very busy Friday. We also rounded again on hospital patients and saw patients in the ER. Again we saw such a variety of patients. Dr. Brown let me see patients ahead of her again and present to her my differentials and treatment plan. It was great to be able to get some more experience. We also went to lunch with Veronica the CEO of the hospital. Wow we feel special, mostly because she took us to the absolute best place in town. Black Hills Burger and Bun was awesome! Ashley and I split our burgers in half and swapped so we could try all the different kinds. I would suggest the jalapeno and cream cheese burger. After clinic was over we hiked up to the top of one of the trails (had to work those burgers off) by Custer AND the Mickelson trail where we found deer, turtles, donkeys, and what Ashley called black deer (cows).
Saturday and Sunday June 14th-15th
Ashley and I spent the weekend in the Black Hills hiking, eating out, and viewing some of the historical features available in the Hills. I am always amazed at how beautiful the scenery is on every hike we go on. We also traveled up to Deadwood where I showed Ashley how to win at black jack.
Monday June 16th
Today Ashley and I rotated between radiology and the lab. I started the morning in radiology. We had a patient come in the ER with a motor vehicle accident so I was able to watch a head CT, multiple x-rays, and the trauma evaluation, which is done upon arrival to the ER. Luckily the patient did very well. I also was able to see a carotid Doppler on a patient. It was a good refresher of the carotid anatomy and risks associated with carotid stenosis. In the afternoon I went to the laboratory and was able to see all of the different tests performed. That is the first time I’ve been able to spend a lot of time in the lab. They really have interesting jobs. We looked in microscopes and got to learn how to run some of the many “toys” they use to evaluate blood samples.
Tuesday June 17th
Well today was a big exciting day for Ashley and I! We were so excited to spend the day with the Custer ambulance. Of course we did not want anyone to get hurt or require emergency services, but we did want to be around for the exciting events if they did happen. We went to breakfast with the ambulance staff in the morning and then went to volunteer at a blood drive they had within the facility. A young girl had fallen at the bottom of Jewel Cave in the hills and had hit her head. So we jumped in the ambulance and sped away to save the day. There was some construction on the road so Ashley and I held on to our “Oh Sheep” handles as we sped through the gravely road construction on the top of the side of a cliff in the hills! We made it to the site and took the emergency gear to the bottom of the cave where some of the rangers were helping the girl. They had stabilized her on an emergency board and sled. She was awake and alert, but pretty shaken up. The emergency service people ended up carrying her on the sled up the equivalent of I’m guessing 20 flights of stairs in the bottom of Jewel Cave. Ashley and I helped carry the emergency equipment back up to the Ambulance and answered questions for the parents. We got back to the hospital and the young girl ended up doing really well.
Wednesday June 18th
Ashley went to the optometrist during the morning and I went to the clinic to spend more time with Dr. Waddell and Dr. Joy Falkenburg. I was able to see patients again and obtain some more experience in my field. Dr. Waddell was also a great teacher. He likes the phrase, “I am not sure what would you do? You are the one caring for the patient come up with a plan.” Which is a great way to learn. He kept me from using him as a crutch and really makes me think, “Oh my gosh I am going to be responsible for making these decisions very soon without somebody looking over my shoulder.”
Dr. Falkenburg is very good with the students also. She is such a hands on teacher. She let me clamp a cervix during an endometrial biopsy. I’ve never done anything like that before.
After clinic Ashley and I went to the YMCA and did an exercise boot-camp with one of the community members. The YMCA is a pretty neat building. Apparently it is the largest log cabin in the United States.
Thursday June 19th
Today we drove to the clinic in Hill City to follow Dr. Graber another family practice physician with Custer Regional Hospital. The clinic was really busy. Dr. Graber has a very thorough and evidenced based practice. He does a great job of explaining his reasoning to patients and students. We had a patient come to the clinic with multiple recent TIAs. So it was good to see the outpatient process for triaging a high-risk patient like this. The situation really reinforced that there is a need for health providers to be present in rural areas. I am not sure that every patient would travel to Rapid City to receive care in similar situations.
Friday June 20th
Today we met Donna a community member at the WEAVE center. The WEAVE center provides care to individuals who are victims of domestic abuse. Donna is a wonderful person who really has roots in helping the community members in their time of need. They have a nice area for these individuals. Donna showed us around the area and had us watch some videos on domestic abuse. It was a good reinforcement of ways to speak to patients who are in an abusive relationship. After our WEAVE appointment we met Dave at the chamber of commerce. Dave took us around town and told us about the best places in the hills to go for activities.
Dr. Joy Falkenburg invited us to her house for a party. They had a live band and tons of guests. Ashley and I were pretty willing for her to adopt us into her family so we could just stay at her home forever. They have a trampoline, zip line, fire pit, and it is in the middle of the hills with nothing but beautiful scenery in every direction. All the hospital staff we saw were very friendly and went out of their way to talk to us and see how our time has been since we arrived a few weeks ago.
Saturday June 21st
This morning I went to volunteer at the Bark Beetle 10k Run in Custer State Park. The run is put on by the YMCA. I wish I would have trained a little before coming to the hills and I would have run. It seemed like a really fun trail. The run started by the State Game Lodge and ended up passing through the creek multiple times. Sometimes the creek was up to waist deep! All the runners got back and said it was one of the best trails they’ve ever run. The medals were also great. They were hand made from bark beetle wood! After the run I took a little nap so I could spend some time in the ER that night. I worked beside Dr. Waddell in the ER. We had a few cases one of which was a patient who had a large hand laceration. Dr. Waddell let me take charge and suture the laceration closed, order discharge medications, and do the discharge teaching.
Sunday June 22nd
I spent the majority of the day studying for my oral defense, but Ashley and I did take a break and went to the movies in Rapid City. The city really is not that far of a drive.
REHPS Week 3
Monday June 23rd
We spend the day in Carson Drug the local pharmacy. My very first time behind a pharmacy counter! I felt like such a rebel being behind the pharmacy counter. I’d never expected that I would ever be in that off limits area. The staff was helpful and very knowledgeable. The pharmacists brought out his natural remedies book. It was really interesting to read about all the supplements that are available and possible side effects that may occur with their use.
Tuesday June 24th.
We met Michelle Lehman and OT assistant and road with her to the Hill City school. We were able to watch her interact with the children. Ashley and I even learned a few new kids games to play. After getting back to Custer we met Nancy, a speech therapist. She took us along with her on a home visit. The patient was post stroke and was working to overcome some receptive and expressive aphasia. Nancy did a great job at working with the patient and helping him overcome some of the frustrations related with difficulty expressing himself.
Wednesday June 25th
Ashley and I spent the morning with a pharmacist at the nursing home. She spoke with us about the importance of chart review and then had us go through the medications the patients were getting to look for outdates. I’ve never seen so many ointments! I went back to the clinic for the afternoon and apparently walked in at the right moment as a student. I was able to help suture a deep laceration on an ear. The ear anatomy is a lot more difficult than the other repairs I’ve done in the past, but I thought it looked great! Dr. Joy Falkenburg let me take the call from the ER nurse when a patient arrived with an asthma exacerbation and order the initial medications. I was also able to go do the initial assessment up in the ER. Then we had another patient arrive with a laceration requiring suturing. I tell you what my suture skills are now pretty up to date.
Thursday June 26th
I deferred from the REHPS program today to take my oral defense in Rapid City. This was a big day for me and I am happy to say I passed! Next step graduation!
Friday June 27th
Ashley and I went to the dentist clinic this morning and watched the dentist place some crowns on a patient. Actually we were both impressed in the dental facilities. They seemed to be really advanced. I would have to say the coolest thing was this 3D printer they use which cuts the porcelain crowns to the exact specification for the patient. It was really neat, but I will actually remember to floss my teeth from now on! In the afternoon we met up with a physical therapist and watched some outpatient rehab. She hooked us up to the nerve stimulator. I had never done that before. It was bizarre! It doesn’t hurt, but kind of tingles like you fell asleep on your arm. The next thing she did was turn the dial up and my fingers flexed up on my hand. No matter how hard I tried I couldn’t get them to extend! We also got to play on all of the cool toys the physical therapists use. I am pretty sure in my next life that may be my profession. Ashley and I took the night to celebrate our hard work. We went to the Purple Pie House and ate the best dessert in the hills.