Adam Goetz on his time in Sisseton
I began with a meeting in the conference room and met with many of the staff of the hospital and the mayor of Sisseton. All of the staff were excited for us to be a part of their hospital for the next four weeks and for us to see their daily duties. As we spoke together, they repeatedly talked about how wonderful it is for the two students (Austin and I) to have such great connections to the community of Sisseton and they stressed to us to look at the whole picture and to keep our windows of opportunities open; as they may be interested in us coming back to work for them post-college.
I spent some time with Dr. Gallagher and his two nurses, Julie and Linda, watching and learning from Dr. on many of his procedures and routines within the rooms with his patients. I participated in some of his routine check-ups. Dr. had me do some ear examinations on his patients in order to diagnose some of the problems he/she may have been having. Dr. Gallagher taught a lot about his practice and how he was able to combine his pharmacist and medical doctor degrees into his occupation. It was wonderful to be able to see the documentation process and thorough exams of each patient, showing respect and attention to each patient he saw. It was interesting, mostly because this is the first time I had seen a doctor’s visit from the physician’s point of view, rather than the patient. After work, Austin and I went with another student named Austin, who was working in the hospital pharmacy, to a gym and got memberships. The gym is called Sisseton Wahpeton Oyate Health and Fitness Center and provided a large variety of exercise equipment for the three of us to utilize throughout the 4-week REHPS program. Austin, my uncle Dave, and I attended the trap shooting night at Roberts County Sportsman’s Club. We had a great time and met some of the local community members.
I have never had much experience on the OB-GYN side of healthcare until I followed Dr. Peterson. She brought me into the exam room with patients, allowing me the opportunity to see the full circle of her duties as an OB doctor. I was able to experience a number of procedures under Dr. Peterson including the inducing of a patient into labor, the regular OB check-ups to monitor the baby’s heartbeat, the removal of a birth control chip from a patient’s arm, a C-Section birth, and a natural vaginal birth all in one day. I will never forget this day, as I put in nearly 16 hours of shadowing/helping at the hospital today. Working from 8 am to 3:30 am, with a 4-hour break, really did put into perspective the dedication doctors have to their patients and the love for helping people. I can honestly say that every minute was worth it, as many of the events were the first time I had witnessed events that I encountered today. Not only did I see these types of first-hand experiences, but I also got to see the most transforming part of it all; watching the mother and father react as they both get to see their 9-month long baby for the first time. It truly is a special moment for everyone in the room. The REHPS experience truly did allow me to see something that I wouldn’t have been able to witness in another type of internship. Seeing the unification of a rural healthcare system team come together and deliver their best efforts at making a patient’s stay is truly inspiring. One unique part of this day was Austin and I wore black dress pants, white button-up shirts, and a black tie with another pharmacy student that was fulfilling his NDSU College of Pharmacy requirements. We planned it and documented it via photo, solely for the purpose of taking a matching outfit photo.
I had the opportunity to follow a P.A., Jackie Bartlett. I was able to watch the way that she performs her routine checkup exams on patients and compare it to other doctors, which made it interesting to see the little differences. Throughout the experience, I was able to see patients that were having a variety of emotional presentations, which allowed me the ability to see how Jackie handled each specific patient by helping as much as she could. I was called to the ER as there was a patient with a rare condition, giving me the opportunity to see another side of the hospital healthcare system. I found it very interesting to be able to walk around to the various departments of the hospital, knowing that each doctor, nurse, surgeon, and pharmacist were all providing for patients together within their specialized fields. Striving to ensure that every patient is equal and deserving of the best possible care. That night the two of us went to an annual Car/Truck Burn-out event, where community members register their car to see who can make the most smoke with their tires. This event was really unique, and it was great to see the community members come together and participate in the local amusement.
We woke up early to set up the Bake Sale booth for the Sisseton Days Relay for Life event on Main Street. We helped a lot of customers, including many cancer survivors, find the perfect treat to satisfy he/she sweet tooth. Austin and I also got to check out the car show that was happening at the same time. It was great to see how the town came together for this event while enjoying each other’s presence on a beautiful sunny day. We drove to Fort Sisseton and had a wonderful time reliving some childhood memories. Going through the various buildings that have historical significance was entertaining. The hospital was ironically the most interesting building there to the two of us. It’s great to be able to enjoy the community around the hospital and see the various events that the community members take part in outside of work.
Over the course of my REHPS experience, I have been able to connect with many healthcare professionals from a number of different departments. Cardiac rehab involved many patients with numerous health concerns, focusing on the ability to get back to a normal, pain free, unrestricted lifestyle. It was great to see it from a student standpoint, as many of the patients are very excited to explain how their initial problems have diminished over the course of therapy. The level of pride in his/her progress in therapy, truly drives the motive of why I am interested in healthcare and having the ability to make a positive difference in someone’s life. I also had the opportunity to visit the ER and help because of the high patient workload. I was able to enter vitals and medications into patient charts and assist by resolving patient concerns. In the ER setting, Dr. Beumer challenged the shadowing students through various questions to keep them on their toes and test their knowledge. It was wonderful to see a hospital setting come together as a team, in times of stress, to manage and resolve all the patient problems that arrived through the main entrance or by ambulance. In the evening, Austin and I enjoyed a round of golf at Valley View Golf Club and experienced first-hand the reason why the course is spoken so highly about.
I spent much of the day in the ER shadowing the doctors, and learning was very beneficial in how to handle a number of various emergency conditions. I was educated on the procedures of admitting and discharging patients. I found it very interesting and exciting to be of any assistance to the doctor or nurses when asked. Having the ability to see the conditions that patients come into the ER have, compared to how he/she is when they are discharged, is remarkable at times. As a student, the ER really puts life into another perspective, as it can be taken so quickly. After this experience, the doctors and nursing staff deserve all the respect in world for helping patients that walk through the door in poor health conditions. In the evening, Austin and I participated in the local trap shooting club outing at Robert’s County range. We participated with two faculty members from Coteau Hospital including an OB-GYN doctor, Dr. Riley, and the Nurse Anesthetist, Chris Fischer.
I had the ability to shadow Dr. Tomboulian and spent the day following her on her rounds to patients in the hospital, checked on patients in the ER, and also had visits within the clinic. I was able to see a number of various settings today and experienced many different patient situations, including the physician side of the healthcare system in each of those settings. Dr. T really was able to turn some of the focus of the medications of some of her patients on me, asking for my input and recommendation. The ability of Dr. T to include me into her duties, and be open to my input, makes me realize how important communication is within the healthcare system. The communication side is very beneficial, not only for the physician asking for feedback, but also for the best interest of the patient. In the middle of her hospital rounds, I met up with Chris Fischer, CRNA, and he gave me the opportunity to see an endoscopy and a colonoscopy. He gave me a pretalk on all of the medications that he uses for this type of partial sedation. Throughout the procedure, the doctor and Chris pointed out a number of unique spots throughout the endoscopy/colonoscopy and the significance of the biopsies in certain areas. From the educational standpoint, it was great to be able to witness this procedure with the doctors providing question and answers. When it comes time to having this procedure, it will not cause any worries as it is a straightforward exam.
Following Dr. Meadows around on his clinical visits was very interesting to see the similarities and differences between himself and his wife, Dr. T. The two doctors have very similar styles of providing healthcare services, ensuring the patient is receiving the best care possible. Walking into the patient rooms with the doctor, allows me the ability to see their own routine with each patient. Checking blood pressure, breathing, ears, eyes, throat, medication reconciliation, and allergies are all common and essential pieces in diagnosing and prescribing correctly. Dr. Meadows made sure that he had enough time with each patient in order to address all of the patient’s needs. One specific experience was the education he provided me on liquid nitrogen, as a freezing method for dermatological procedures. Focusing on the underlying cause of the patient’s problems is essential in correcting the root of the health issue.
I was able to spend some time within the hospital pharmacy setting and learned the daily routines of the pharmacist. I was able to go through all of the medication kits that the pharmacy provides to the ER, hospital, labor room, operation room, and radiology. I went through and made sure that the correct medications are in the kits and that the medication is not expired. I also collected all of the medications from the pharmacy and filled the two Pyxis machines in the medical/surgical room and the emergency room. Once I was done there, Chris Fischer came and got me for another procedure. I was able to see the removal of two cancerous dermal spots on a patient’s back and a skin lesion. Dr. Riley was doing the procedure and showed how to suture up an incision. The course of anesthesia varies between various procedures, which was explained by Chris within this procedure. One thing to note was this week within the hospital, the food that was provided for lunch was always exceptional. Personally, this piece was a bonus to the overall experience.
I was able to spend some time with the P.A. Brad Gallagher. I found it interesting to be able to compare the way Dr. Gallagher and Brad diagnose and analyze patients and the similarities between their two practices. Brad explained many different reasons for prescribing certain medications over others, which was very beneficial to me as a pharmacy student. I was able to see from the physician standpoint of the decision-making process which medications would be best and the reasoning behind that choice, too. I find clinical family practice to be a lot of fun as it brings in families and community members for a number of different reasons, and it is up to that physician to determine the best suitable treatment for the particular patient.
I had the opportunity of following Dr. Morales today. Dr. Morales is the general surgeon of the hospital at Coteau Prairie and is a fairly new addition to the hospital’s healthcare team. I began the morning with a surgery of a lipoma on the shoulder. I was able to see the procedure, observe the operation process, and ask questions. Having the chance to witness and observe the operations first-hand is a very good experience for anyone in the medical field. Chris Fischer, CRNA, also allowed me to see his course of duties in that type of procedure. Once that was done, I was able to see another procedure where Dr. Morales completed a stenosis of the Gastrointestinal opening between the stomach and intestines. The procedure involved a scope exam of the narrowed opening, which was then dilated with a hydraulic device. In between the three procedures, Dr. saw a couple patients for post-op checkups.
I had the opportunity to assist Dr. Morales in a procedure involving an incarcerated umbilical repair. I learned how to properly scrub and garb up. Dr. Morales had me assist him by holding clamps throughout the surgery to keep the site open, hand any tools he requested, use scissors to snip the remaining thread after each suture, and use the sautering machine to remove unnecessary flesh or tissue. It was an incredible experience as I have never been so involved in a sterile operation that used complete intubation of the patient. One thing that the Dr. said was how important it is to have steady hands, and he noted that he was impressed with how I controlled my hands and tools and thought I was a natural in the surgical field. I took that as a compliment with a grain of salt, as I have to remember that I am a pharmacy student and will not have these types of opportunities on a regular basis. Throughout the operation, getting asked questions also helped me learn a number of new things that are very important in each procedure.
Having the ability to meet patients before and after surgeries is very important from an educational standpoint. Initially it is difficult to see patients in pain or discomfort, but then it is resolved with the doctors intervening. Following the procedures, it is interesting to see how the patient progresses from the medical treatment and returns to a normal lifestyle. As a student, witnessing the patient satisfaction expressed to a physician on the post-op appointments truly reiterates my decision of choosing a healthcare occupation.
Following the long workday in the hospital, Austin and I went south of Sisseton to Agency Village and worked out at the local gym there. After working out, I got ahold of Dr. Staub and he allowed the two of us to go into the old Sisseton middle school gym and play basketball for a while. He gave us a little tour and explained a bit of the history of the school too! Following basketball, we ended up going out to Roberts County Trap Range to shoot clay pigeons with some of the community members again. The interesting part about tonight was that there was a tornado warning and we ran out of clay pigeons about 30 seconds before the wind started and the down pouring began. We luckily got out of there in time and made it up to the hospital before it got too bad. All of the patients in the hospital had to be moved to the hallways and away from the windows, which was not ideal for some of the patients in their conditions. Prior to going to Agency Village, we asked labor & delivery department to give us a call if the induced patient was ready to give birth while we are out of the hospital. When we got back after the trap range, the baby still had not been born so we just waited around. Around 1:00 AM we finally had the opportunity to watch the natural birth and all the excitement that came with it. Call watching as a student, and seeing the joy that is expressed by the family is really a memorable experience. But we still weren’t done, even though it was about 2 AM. We were then sent down to the ER where a patient had a broken femur and another had suicidal ideation. Watching the Dr. follow suit and provide the patients with care was a great experience too. After the x-rays were taken on the femur the doctor made arrangements to discharge the patient to a bigger facility. With the suicide ideation, it is really important to remain calm and be completely understanding with everything that the patient was saying and almost act as a counselor in order to determine the right treatment for the patient’s condition. The nurses finally made us leave because it was getting too late and we had to be up early and ready for another procedure before 8 AM. This is one day that was full of opportunity and great experiences as a student in the healthcare field.
To begin the day, Austin and I went to the operating room and helped with a cholecystectomy. We actually had the ability to help as we watched the procedure. Throughout the procedure Dr. Morales provided the two of us with question-and-answer situations as he quizzed us on the human anatomy. It was great from an educational standpoint, having that ability to visualize and understand each step that Dr. accomplished in order to provide a successful gallbladder removal. Following the procedure, we went to the ER and provided our own services in every manner that we were able to. The ER had patients coming in at a constant rate, allowing us to see a number of interesting patient diagnoses. Having the ability to access each patient and resolve every problem that comes through the door is a very difficult and demanding duty to be responsible of. We had the opportunity to see a range of patients involving a complete break of the forearm, constipation, syncope, a rapula fish hook lodged through the ear cartilage, and a migraine. Two of the patients that I won’t forget where the broken arm and the fishhook because I had full participation in their emergency room treatment. Nate, who is the ER wiz and a nurse practitioner, had me put gloves on and assist with putting the splint on the broken arm after sedating the patient. Watching Nate put the arm back in alignment was something that I have never seen before. Although I wouldn’t wish it upon anyone, it was great to see the orthopedic procedure from the emergency room standpoint. Nate is really good about explaining the situation of each patient and then demonstrating to Austin and me the steps of how he is going to treat the patient. For the fishhook patient, they used lidocaine within that ear prior to snipping one of the three prongs that were puncturing the ear. One hook was removed at a time until all three were out and the patient successfully had an ear free of fishhooks.
I was able to follow Home Health and see some of their patients. One thing that I realized from this experience is how blessed I am. It was a great way to have a reality check and look back on all of the things that I have. We entered the patient’s houses and examined, cleaned, and assisted them in any way that we could. Witnessing how some patients live in poor conditions, truly meant a lot to know that we helped them. We made three different house visits and helped those patients with any concerns he/she may have. As we were there, we provided care to wounds, checked their medications, took their vitals, and made sure that the patient was comfortable. Following my experience in home health, I shadowed a physical therapist with Big Stone Therapy. Our first patient had previously had a total knee replacement surgery. The PT explained the exercises and difficulties that this patient was experiencing and how to alleviate those symptoms. We then made two house visits involving a patient with a total hip surgery and one from a motor vehicle accident. Analyzing each patient is important in order to get them back on track to living a life that he/she once did before surgery without any complications. Using special muscle exercises and stretches helps the patient manage their symptoms. Today I was able to see how certain home bound patients receive help and care following a surgery or injury. It is interesting to know that these businesses are all under the same roof as the rest of the hospital, clinic, ER, OR,radiology, and the Coteau des Prairie administrative services. After PT shadowing, Austin and I drove to Beardsley, MN and had some of the well-known wings with the nurse anesthetist of the hospital, Chris Fischer. We then proceeded to socialize with some community members at a hometown establishment.
Austin and I begin the day with a little bit of time in the pharmacy. We then went and talked to April, a nurse, about her daily tasks and how HPAP (Healthcare Professionals Assistance Program) works within Coteau. Following that meeting, Austin and I went to the Indian Health Services clinic and got to participate in a conference called “First 1000 Days Inter-Agency Forum”. The group taking part in this forum is working on “creating collective impact in the first 1,000 days of life for healthy, resilient families on the Lake Traverse Reservation.” They have been conducting a survey on the relationship between the mother, father, and the newborn to study the first 1000 days of the child’s life from conception. It was interesting to hear from each person at the meeting on their opinions about the topic. We met a lot of community/IHS members at this meeting and even provided some of our own input to try and help support their initiative in bettering the lives of newborns and their parents.
After the meeting concluded and lunch was over, we met with the respiratory therapy nurse, Collette, and learned about the respiratory department and when she gets involved in patient respiratory conditions. Following respiratory, we are able to talk to laboratory workers and learn about blood, stool, urine, and other specimens. Austin and I learned all about the cultures and how they test for each bacteria, virus or parasite. We learned how they run blood tests in order to get CBC, TSH, ABG, and all the blood exams that explain a lot about a patient’s condition and well-being. I found it very interesting to see how the process begins with the doctor ordering the blood tests and how it transmits into the lab testing for each of the ordered blood exam specimens. The two of us then met with the radiology department and learned about all the different options as far as a CT scan, ultrasound, bone density scanner, and X-ray imaging. The radiology technician showed us CT scans of very distinct pictures of patients with interesting CT scans including aneurysms, obstructed bowel, and a broken bone.
This evening, Austin and I went to his house in Rosholt, SD. The two of us went to his high school and worked out before I received a tour of the old halls that he used to roam as a student. We then went to his house and I met his family members and had a nice walleye dinner. I then received a tour of Rosholt and got to see their family furniture and crematorium businesses. It was a great way to end an eventful third week of REHPS. Only one more week to go, which isn’t something that I am excited about because of all the educational and thrilling experiences that I have had while being here.
I began my last Monday as a REHPS student by spending some time in the pharmacy talking to the pharmacist and technician, Michaela and Britteny. I then went to a meeting with the Quality Improvement nurse, Brenda, and she explained everything about the hospital’s policies and protocols for their facility. The information regarding the facilities Quality Improvement Plan is interesting as it gets all of the facility reaching for optimal patient satisfaction, while staying within the healthcare professional’s scope of practice. I then spoke with Chris Fischer, CRNA, in the doctor’s lounge about advice on life, which led me to realize how much of a resource he is outside of being a nurse anesthetist and putting people to sleep. One of his helpful advice measures for surgery was, “1) When you can eat, you eat. 2) When you can sleep, you sleep. 3) The longer you stay, the longer you stay.” Good communication within a healthcare facility is beneficial to both the employees and patients. I then went to the ER and talked with Dr. Beumer about the current patients and some of the CT scans that occurred over the weekend from a vehicle accident that resulted in multiple fractures. From an educational standpoint, it was good to see examples of injuries through a CT scan, as it provides as a good model for future referencing. After a little visit to the ER, I went and shadowed Dr. Peterson, OB-GYN, and got the opportunity to see an OB checkup for a patient that is going to deliver before the expected date. Dr. Peterson explained to me the use of betamethasone and why it is important for administration in order to assist in the development of the baby’s lungs. That evening, the Director of HR, Leslie Hendrickson, brought me out to the cabin on Clear Lake that the hospital rented for Austin and I to stay in during the last three nights of our REHPS experience. The lake cabin was supplied with a number of recreational things to do on the lake, including kayaking, canoeing, relaxing, fire pit, fishing, and many others. We were really excited and appreciative of this opportunity that was made available to us from Coteau des Prairie Hospital.
We had the opportunity to have a tour of Indian Health Service clinic. We were able to speak with Elliot Klapperich in the pharmacy and learn about all the tasks that the seven full time pharmacists must do on a daily basis. We saw their counseling room, how to manage all of the medication orders, and also the robot that dispensed 175 different medications through. The head dentist of the clinic showed us around the entire dental department including the dental chairs, oral X-ray machine, and sterilizing process. The facility is really interesting as the Native Americans seek needs focused on dental, clinical, and lab work. I then was able to follow a nurse practitioner, Angie Gaikowski, and was able to follow her in on a couple of her patients. Austin and I spent some time working on a first aid presentation for 4-H youth at an event held at Sisseton’s 4-H grounds. It was great to see how interested the children were to learn about the subjects that we talked about including sunscreen and bug spray directions of use, sting relief wipes, band aids, wet wipes, and how to stop a nosebleed. The children were excited to ask many questions and were very curious about our personal lives as students in college. We also shared with them what each of our majors in college were, what was involved in our jobs, and how we will help people when we are done with college. It was great for Austin and I to participate in this event as we were able to educate and have fun at the same time, while helping out the community. Following the 4-H event, we had the opportunity to go out to the cabin and relax on the lake. We were able to grill out, kayak, fish, and stargaze when the sun finally disappeared, as it was the longest day of the year (June 20th).
I had the opportunity to spend some time in the pharmacy with the Pharmacist, Michaela, and talk about options and opportunities involving pharmacy. I was able to get some work completed on our REHPS celebration day PowerPoint, which is full of images and descriptions from throughout the experience. For lunch, Leslie Hendrickson (HR), took us to the Hickory Street Restaurant. We talked with her about how our experience at the hospital has been and all the different things that we are able to participate in. It was a great way to wrap up our stay and to provide some feedback to her about opportunities that may have been better than others for future students. That evening, Austin and I were able to relax at the cabin and finish up our REHPS Celebration Day PowerPoint. We were able to go out on the kayaks and sit in the middle of the lake while watching the sun set over the trees. We got really lucky because following the thunderstorm that went through, it completely cleared up.
We enjoyed sleeping in a little bit this morning because our REHPS Celebration Day Ceremony wasn’t till the afternoon, which let us have time to enjoy the last moments we had at the cabin before we departed to the hospital. Austin and I just want to recognize the hospital and the healthcare facility for providing us the cabin for our last couple of nights. It really allowed us to decompress and reflect over all of the opportunities that we had throughout the previous four weeks. At the hospital, we finished up the last parts of the PowerPoint and then presented to the healthcare system staff, our families and Cheri Buffington. We were able to express how deeply thankful we were to have the opportunity in Sisseton at their facility.
It is really tough to put into words how thankful I was to have this opportunity and participate in this experience and Sisseton. The staff and the healthcare professionals did an incredible job in providing Austin and I and an amazing opportunity that neither of us will ever forget. From the patients that we are able to assist with in the emergency room to the patients that were having a procedure done in the operating room to the patients that we were able to meet with in the clinic, it all added to the experience and helped each of us reestablish our interest in becoming health care professionals one day. Having the ability to witness patient satisfaction following a procedure or clinical visit really showed me why I chose a major that dealt with healthcare and helping improve people’s quality of life. All of the staff at Sisseton’s healthcare facility and those in the community were outgoing, caring, and welcoming in all aspects of this experience. This is an experience that will stick with me for the rest of my life.