Rebecca Runge
First Week at Miller
I was overjoyed to have the opportunity to obtain clinical experience in Miller, SD this summer while also spending quality time at home just 12 miles away in Wessington. Growing up in a small rural environment, I thought I knew what I would see while interning at the hospital – runny noses, diabetes, hypertension, and maybe the occasional trauma in the ER. After completing my first week of the REHPS program and following various providers in the clinic, hospital, and nursing home, I cannot believe how naïve and unprepared I was. Family practice takes on a whole different meaning when you’re out in the country and the nearest surgeons or specialists are an hour and a half or more away.

In just one day, we treated a toddler for epilepsy, checked numerous INRs and adjusted patients’ Coumadin, removed cancerous-looking skin lesions, put in and removed stitches on different patients, treated a case of erysipelas, completed physicals on school age kids to grandparents. All while forming personal connections with each and every patient. I think that is what shocked me the most. Patients are so trusting in their caretakers here and all were extremely curious as to who I was. Most could name more of my ancestors than I could and all were more than willing to let me practice my skills on them. Physicians quizzed me and answered my questions respectfully while also looking to me for consultations on things they may have forgotten or trusting me to take histories when they were running behind. I wake up each morning excited to start my day and fall asleep each evening imagining what coming back to practice here would be like.

Week Two
Monday was Memorial Day and with the clinic being closed, I was able to cash in on a three day weekend that left me rested and ready for another week in Miller. As I began reviewing my schedule for the upcoming second week of my REHPS experience, I had a few reservations that lingered in the back of my mind and made me approach the week with some trepidation. Mixed into my usual line-up of clinic hours I would also be spending time with respiratory therapy, radiology, physical therapy, and the home medical departments.

I arrived at the clinic Tuesday morning and headed straight to hospital rounds, eager to begin my day with Dr. Hopkins. The previous week he surprised me by trusting me to take histories on patients and report back to him. This week, the stakes were upped as he now felt I could not only do the history but also begin the physical exam and establish a differential diagnosis when I gave him my initial report. While these were all things I had learned during my first year of medical school, I hadn’t had the opportunity to put my skills into practice on real patients. I am incredibly grateful to Dr. Hopkins for pushing me out of my comfort zone and providing me an opportunity to gain confidence working with patients and identify areas I needed more practice with or concepts I needed to brush up on that hadn’t stuck in my head. I also had my first experience with removing staples!

I was pleasantly surprised Wednesday as I spent time with respiratory therapy. I expected the day to go by slowly as we helped people breath, fixed CPAP machines, and administered nebulizer treatments. However, I quickly learned that even if her title was respiratory therapist, the actual job duties included many other things like delivering and selling home medical supplies and overseeing telemedicine visits.

I had been on the other side of telemedicine conference calls with physicians but it was a unique aspect to see it on the rural side with the patient. This technology saves patients and doctors time and money as well improves follow-up care. Most patients would not drive another 3 hours just for the doctor to look them over for 5 minutes and send them on their way or possibly find something that needs addressed. Telemedicine is convenient so that patients are more willing to take the time for these necessary follow-ups.

As much as I enjoyed respiratory therapy and time with home medical, I quickly discovered radiology and physical therapy were not for me. I am happy I had the opportunity to spend time observing their part in patient diagnosis and recovery and I am truly grateful for the people who have a passion for these fields. I realized I lack the necessary patience needed and I liked putting the puzzle together between symptoms and diagnosis and playing a role in the patient’s care from beginning to end. My time with them reaffirmed my career choice to be a physician and I found myself choosing to be in the clinic and ER for the rest of the week.

Week Three
It’s hard to believe I’m already beginning my third week in Miller and my REHPS experience is half over! I spent the weekend enjoying small town living at Wheel Jam in Huron. I was able to sneak in some family time by attending the People’s Choice BBQ contest with my brothers, and I even talked Lauren into going to the Johnny Holm band with me Saturday night and introduced her to a few friends. I was surprised how many people I saw there that I hadn’t talked to for months but it also reminded me of why I love living in a small town area where everyone knows everyone even in a town 20 miles away. As much as I enjoy the privacy living in a bigger town like Sioux Falls offers, I miss the feeling of randomly running into people I know who genuinely care about what is going on in my life and want to catch up.

After a fun-filled weekend, I was motivated for another week in Miller at the hospital especially since this week my focus was clinic, clinic, and clinic with as much ER time as allowed. I was quickly gaining confidence and experience performing histories and no longer felt nervous to report back to the physicians until I was called in to the ER one night knowing only that a young adult was having abdominal pain.

Dr. Hopkins met me in the report room and told me to get started working the patient up. I blankly stared at him and stuttered something about me, experience, this is the ER. After a brief pep talk, I grabbed my stethoscope, hoping it would make me appear more confident than I was, and went to see the patient. As luck would have it, I acquired the hiccups just as I took the final two steps to reach the patient’s bedside. The patient was a good sport though and I grew even more comfortable with patient interactions and learning how to create a differential diagnosis in addition to keeping a calm head during emergency situations.

I also spent a day in the lab which provided me with valuable insight as to the limitations of rural medicine. They are capable of running more tests than I realized but many of the better diagnostic markers must be sent to an outside facility which then takes another day to receive reports back. Providers have to be conscientious of this fact and innovative to choose tests that can be run in the facility for quick diagnoses but also not compromise patient care in doing so. I had the same experience in radiology where MRIs and ultrasounds have to be done elsewhere so physicians must take into consideration how necessary it is or if CT or plain films could do the job instead.

I cut my week short a day to head to the river for the annual Wessington Fishing Derby and remind myself how tight-knit our community really is. Another aspect of rural living that I really enjoy is that deep sense of community support. Basically, the whole town packs up and relocates to the river for the weekend and families who have moved away make it a priority to be back for Derby Weekend!