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Week 1 Sisseton, South Dakota

5/27/14
Verse of the day:
The LORD has remembered us; he will bless us; he will bless the house of Israel; he will bless the house of Aaron; he will bless those who fear the LORD, both the small and the great. (Psalm 115:12-13 ESV)

Synopsis:
Today was my first day of work, I was really impressed with the hospital and all the resources they have available. For a town this size to have all that equipment available is pretty amazing. I am looking forward to getting to know the town better as far as what is the “heart-beat” of the town and what really brings life to the people of Sisseton.

What I am thankful for:
I’m thankful for Leslie Hendrickson doing so much work to get a good experience lined up for us and for taking the time to introduce us to what seemed like pretty much everyone in the hospital. I’m thankful for our housing situation which is quite generous of the program to have provided us with such a great place to stay. The landlord is great.

What I learned:
Dr. Kleinberg quizzed Eddy and I a lot, which was cool because I think that was the first time I have been grilled to that extent by an attending. I got stumped a lot and didn’t know some probably basic things but I did know quite a bit which makes me thankful for my school.

5/28/14
Verse of the day:
“The Lord preserves the simple; when I was brought low He saved me. Return o my soul to your rest; for the Lord has dealt bountifully with you.” Psalm 116:6-7

A lot of times I think I would be a lot better if I was a more simple man. I think in this passage “simple” is getting at a child-like trust in God, children are quite trusting when their parents make them a promise and they truly expect that promise to be fulfilled. Also, the simple man is not in a constant pursuit of stuff, he’s thankful for what he has already been given. He notices the sunrise and sunset, the flowers of the filed, the food on the table, and the people in his life. He doesn’t need more stuff to make him happy, because the Lord is his rest and his joy, and that is more than enough for anyone. Thus the simple man is able to say “thank you Lord, for You have dealt bountifully with me.”

Synopsis:
Today was a big day. I got to the hospital at 6:30 am and left at 8:30 pm. I was with Dr. Gallagher, a family practice physician and I learned a lot. I think more important than the medical information I learned, which I learned plenty of, was the lessons I learned from how Dr. Gallagher conducts his practice and how a few small things he does means a ton to his patients.

What I am thankful for:
Dr. Gallagher let me put in my first stitches today! It was only two stitches but still that was the first time I had done them on a real patient so I was definitely quite excited. One of the stitches I put in was a little crooked, but it turned out to help approximate the wound better so I guess I had some beginner’s luck. (Thank the Lord).

What I learned:
On every single patient Dr. Gallagher sees, he takes their blood pressure, listens to their hearts and lungs, checks their throat and ears, goes through a brief review of systems, and goes through all their medications. He is the first doctor I have ever been with that does that. I asked him about it and he said that he is not the smartest or best but he has a huge and successful practice because patients really appreciate him taking the time to do that and it really does not take that long to do. I think that is a lesson I will carry with me throughout the rest of my career.

5/29/14
Synopsis:
I walked into the hospital at 6:45 am today and by 6:55 am I was in the Operating Room (OR) watching an emergency C-section, it was intense but it went well so that was great to be a part of.  A couple hours later we got to watch a normal vaginal birth so that was great to get a double dose of obstetrics today. Then we saw a colonoscopy, circumcision, and rotated between the ER and clinic.

What I am Thankful for:
I saw how much a kind nurse can help students today. There was a nurse named Linda who worked the night shift and was there when we first walked in today. Even though it was the end of her shift she showed Eddy and I where the OR was, where the locker room with the scrubs were, and exactly where to stand in the OR. Then during the night when I was getting to screen patients and give report to the doctor, Linda gave report to me like I actually knew what I was doing!  :-)  That was kind of her and I appreciated it.

What I Learned:
Dr. Staub taught me about how to learn as a medical student. He told me just to go for it with patients, examining and interviewing them myself to get my own idea of what is going on and what tests I would order. Then, when the attending physician goes in to note what he/she does different and what questions they ask that I did not so that I learn with every patient. Dr. Staub dismissed Eddy and I early in the afternoon and I came back at night to get more experience in the ER, he told me I should be out experiencing the town and having fun, noting that as a physician you need to know when to hand off the work to the next person. Good lesson to learn early…

5/30/14
Synopsis:
Today wasn’t quite as fast pace as the other days this week which was good for me to catch my breath. I spent the early morning with Dr. Staub in the ER and in the hospital and then spent most of the day with Dr. Gallagher in clinic. After we got done with work, Eddy and I went over to Sica Hollow State Park and hiked around for a while so we are pretty much ready to be deep jungle tour guides now!

What I am Thankful for:
I got to interview somewhere around 7 patients today and try to work up a diagnosis and what I would order to help out these patients. The first 6 I was usually on the right track but couldn’t get everything all put together. Some were complex and had to be admitted, but it was good to apply all the things I have been learning in school. Then finally on the last one I gave Dr. Gallagher my assessment, gritted my teeth while he did his physical exam, and when he told me I nailed it I was about ready to run up and down the halls and let everyone know I finally got one.

Week 2
6/2-3/14
Compassion
Many Samaritans from that town believed in him because of the woman’s testimony, “He told me all that I ever did.” (John 4:39 ESV)

This verse is about the “women at the well” who was an adulteress but Jesus loved her all the same even though He knew all she had ever done and she was of a different race and religion than He was. He showed love to her when everyone else, even those in her community, thought she was trash. As a result she ended up playing a big role in the rest of her community getting to know Christ.

A doctor once said to our med school class “a doctor is only as good as the way he/she treats the patient they like the least.” Today I saw a lot of patients who came in basically just so that they could get more pain meds.  I’ll be honest, with one of them my mind thought of the person as a drug-seeker because of the way this patient was acting and I didn’t see past that. Jesus saw past the transgressions of this woman and saw someone worth loving. He saw potential in her even though maybe no one else even she saw it. I need to strive to see people this way more often.

6/4-6/14
Patience and Humility

…walk in a manner worthy of the calling to which you have been called, with all humility and gentleness, with patience, bearing with one another in love… (Ephesians 4:1-2 ESV)

Looking back this has been a really great week, I have been learning some lessons I didn’t think that I would learn up here. This is my first real clinical rotation so I think I’m going through the bumps and bruises of learning how to be a good medical student not just in the books but when patients are involved.

Honestly, I had a few harder days this week, everybody has hard days it can’t always be rainbows and butterflies… The doctors I was with were super busy; they saw a ton a patients so they didn’t really have time to slow down and explain things to me rather it was a lot more watching. In hindsight it was super gracious of the doctors I was with even to let me tag along because having a student definitely slows them down. At times I got frustrated because I am still learning to ride the line between being ambitious to speak up when I want to try something and patiently waiting for doctors to present me with opportunities at the right times. This week there was less of doctors pulling me in to show me something interesting and more of me needing to show interest to find opportunities.

I called a friend of mine who is just finishing up her residency and asked for her advice. She gave me some needed perspective about how busy the doctors were and also about how to be a good student. She pointed out that as a resident there are days she still spends a lot of time just watching, and also that pushy medical students who think they know how to do everything are not looked upon real well by doctors and residents. Ultimately, she told me to be an active learner, to jump in when opportunities present but also to try to ask questions that show that I’m paying attention. Furthermore, she told me she wished that she had started taking notes on things she saw and reading up on them at night earlier in her studies. So I tried to ask one good question about each patient when walking in the hallways between seeing patients and took more notes on things to look up that I didn’t know. After that the days went a lot faster and I learned a lot more. So that was the patience I learned.

Humility came on my third suturing opportunity since I’ve been here. I have done sutures under three doctors and each goes about it a little different. The first two times the doctors just kind of let me go on it and at the end told me I had done really well. So with this third patient I was getting a little cocky like I had the whole suturing thing down. So I started at it and soon it felt like this doctor was pointing out things I could do better about left and right all in front of the patient, which was a little embarrassing. At first I was a little angry, thinking that because I had done it almost flawlessly the last two times I was above reproach. Then I took a deep breath, and reminded myself that this doctor had been practicing almost twice as long as I have been alive and that 2 live suture experiences did not make me an expert. So I took a humble pill and listened to what he had to say being thankful for his critical eye and willingness to point out places to improve upon in my technique.

**Nurses rock! Thank you to all the nurses out there who help lost and confused medical students. The ER nurses here have been so great to me, always pushing me to see more patients and helping me through different procedures that I’m not the most confident on. I went in to screen a patient once and when I came out a nurse asked me if I had any orders I wanted to put in as if I was a real doctor, at first I almost laughed to myself because at the time I really didn’t know what I would order. But then I was just really thankful, it was an older nurse and knew what she was doing so it was very kind of her to treat me that way.

Photos from Week 2:

Week 3

6/9/14-6/10/14
Monday and Tuesday of this week I spent time with Drs. Beumer and Staub respectively and on Monday night spent some time in the ER with Patrick, a PA from Milbank. This week I am seeing a fair amount of patients for a second time, as I saw them my first week or in the ER at some point. The continuity of care coming up after only two weeks is cool to see especially because many of the older patients like to joke around and have a good time while they’re here so it’s been fun to build that relationship with a few patients even after only having been here a few weeks.

Throughout this experience I have had the opportunity to see a large volume of patients, which means I have gotten to see a wide variety of conditions. In school the amount of pathologies, diseases, and drugs we learn drinking from a fire hydrant so you just pick up as much as you can, but when I actually see patients with these different conditions the things I have been learning in school make so much sense. Furthermore, it’s much easier to remember these different conditions when I can remember the face of patient to go with it.

6/11/14-6/14/14
This was definitely a crazy week which provided me with a ton of experiences and opportunities to learn. Some of the highlights were getting to put more sutures in, spend a lot of time in the ER and help get a hold of a neurosurgeon in Minneapolis, and see another C-section.

Not a day goes by that I don’t hear a patient tell me that the doc I’m following is just the best and how thankful they are to have that doc caring for them. Even as I get to know people outside the hospital they want to know which docs I have been following so that they care share some stories about how well that doc cared for them at sometime. I really enjoyed the time I got to spend in Obstetrics this week because of the excitement of seeing a family come together over the birth of a child and how the thankful and trusting they were towards the doctors involved. I look forward to building these kinds of relationships with families in the future.

On a side note, I ate three 13+ oz. steaks this week and didn’t pay for any of them. The people out here have been so generous in getting to know me and inviting us to do life with them out here. I couldn’t make it home for Father’s day, but a family from church invited me over to their house and I got join them for a big family dinner. It was so kind of them to let me be involved in their family like that. On Thursday night Eddy and I got up on our co-worker Sheila’s horses which was a ton of fun as well.

Week 4

It’s hard to believe things have come to an end already, it has definitely been a fast summer. I learned a lot of really great lessons, some of which I think I may carry with me for the rest of my career. I put my first IVs in, my first catheters, saw my first C-sections along with a variety of other surgeries, got to be first assist for a surgeon for the first time, put my first sutures in, and did exams with real patients for the first time. In med school so far it has really been a ton of book work so getting out her and getting hands-on experience has been really helpful for reminding me why I decided to become a doctor in the first place. I think as far as practical skills go the most important gain I made this summer was getting a feel for what normal is. In med school we learn all the things that can go wrong but we don’t see many patients yet so it is hard to get a feel for what is normal and what is abnormal. The doctors up here gave me the opportunity to do physical exams and diagnose a bunch of patients up here so now I think I have a base for saying what is normal. Now when I see abnormal I will know it.

More important than practical things I learned were a few lessons about being a medical student and about being a physician that I will carry with me throughout school and my career. This was my first extended clinical experience as a student so I got a taste of what to expect of future clinical experiences and how to be brave in stepping up when I want the opportunity to help with some procedure but also being patient and wise in waiting for the opportunities to present themselves. Dr. Gallagher also gave me a practical lesson that I will carry with me throughout my career. I still remember him telling me that he isn’t the smartest or best physician out there but because he does a thorough physical exam on every patient that comes in his patients feel like they are receiving exceptional care every time. Because of this I think he has the largest practice in Sisseton and many of his patients love him. Even though he doesn’t spend as much time with his patients as some of the other physicians might, his patients really feel like they are getting ample time with him. Watching Dr. Beumer showed me how through showing kindness to patients physicians can earn an extremely deep level of loyalty from them. Dr. Staub was an example of being calm under pressure, even when he was behind and there was a ton of patients to see he didn’t get rattled.

I’m really thankful for all the work that went into my experience in Sisseton. I know there is a ton of behind the scenes work that went on to open the doors for me to be up here, and I think the investment made in me will help me make a difference in the future.