Ashley Brunick, Physician Assistant Student, on her time in Freeman
The morning I got here, Ruth, the foundation coordinator, greeted me at the front door of the hospital. From there, I met about 20 people at the hospital who all greeted me with a smile. “This is Ashley, the PA student from USD that will be working with us for the next 5 weeks.” My partner had class the first day, so I was on my own. I got thrown right into the hospital for rounds, and we sutured a patient’s elbow in her hospital room. There were only 3 patients in the inpatient setting! From there, we went to clinic (attached to the inpatient portion of the facility) and saw a few patients. It was evident that Terri, my PA preceptor, was very invested in her patients and they were very appreciative of her! Before long, I had Ruth coming to take my lunch order. We ate lunch then headed to Menno for clinic and nursing home rounds. This is when I realized how rural Freeman and Menno really were. We showed up at the clinic and asked whom our first patient was. The nurse, Ashley (J), told us, “Our first patient is John Doe coming in for leg swelling — of course his legs are swollen! As I drove to work, I saw him out mowing his lawn!” This was an almost 90-year-old man that was very well known to the community. Once I came “home” from Menno, Ruth and her husband, Dale, had me over for dinner at their house. It was a fantastic meal, and I already felt at home with them. Later that night, I went to my host family’s home to stay the night.
The next morning, I met up with my partner, a Master of Social Work student. We had orientation to the facility and ate lunch from Blue’s Pizza. Coincidentally, the owner of Blue’s is the son of the owner of Little Italy’s Italian restaurant in Vermillion. What a small world! In the afternoon, we went to the local newspaper printing shop, the Courier. We then went to the local second-hand store and met a few of the individuals who worked there. Ruth then took us to Freeman Academy (one of the two high schools here in Freeman) where we watched the Hesston College choir perform. It was a fantastic performance!
The next morning, I woke up and went for a nice run around the Freeman community. We attended the HOSA meeting that works to teach high school children about the medical profession. This community is constantly trying to expand and bring programs into the community to help the children and the people living within. We then went to Menno for a morning of clinic. That afternoon, we came back to Freeman Regional Hospital and met with individuals at the care center. We then met with Tony, the Physical Therapist, who told us about his past 21 years of experience at Freeman Regional – he loves that they allow him to be a part of his children’s lives while also working. That evening, we had a nice meal at Ruth and Dale’s home with my hosts’ Dennis and Shirley. It was nice to sit around the dinner table and talk for a few hours about our past experiences.
Friday morning, I woke up and went for a run on the treadmill in the Physical Therapy Department at the hospital. They allow faculty and students to use their equipment before 8 am and after 4:30. Perks of a small facility! We then spent time in the hospital with Dr. Kirton and spent some time in the Radiology Department watching our own patient’s CT scan! It has been a good first week in Freeman, and I have really enjoyed living the “rural life!”
On Monday morning, we started our day at the Marion clinic with a DNP. At lunch, we were picked up and taken back to Freeman Regional Hospital for an emergency response meeting. At the meeting, there was staff from the hospital, from all departments along with EMS personnel and firefighters from the community. Together, they worked to determine what needs to take place for the following scenarios: severe weather watch/warning and tornado watch/warning. It was enlightening to see the community work together to determine the best safety protocols for the patients of the hospital, nursing home, and community. After the meeting, we followed in Jenna’s role, social work. We were working on the documentation for discharging a patient from the hospital and admitting them to the nursing home. Interesting thing was that Amanda, the social worker, played both roles at this small facility. Amanda has a sign in her office that I thought was pretty accurate; I should get a picture of it one of these days. It was one that pertained to social workers and said, “what my mother thinks I do” with a picture and “what my friends think I do” with a different picture. The one I thought was fitting was the one that said, “what doctors and nurses think I do” with a photo of an individual waving her wand to make magic happen. Seriously! Social workers do make magic happen and we are lucky to have them in the healthcare system. At night, we went to a local grill for dinner at Meridian Corner with Jenna’s host family, Ruth and Dale, and the “retired” but still working at the hospital DON. It was a fun night, as we shared many stories around the dinner table!
On Tuesday, I spent the morning with Teri in the clinic. We saw patients of all ages: from newborns to patients over 100 years old! She really has to know it all, working in a rural clinic – the childhood vaccination schedule, childhood developmental milestones, how to manage irregular menstrual cycles, how to complete a work physical, the side effects of certain medications, the doses of medications, etc. After lunch, I met with the dietician that comes all the way from Brookings to talk with WIC patients. I learned a ton about who is eligible and how to read the checks (and now cards) they hand out! It was an interesting experience. I then went to Menno to spend the rest of the afternoon with the community health nurse and birth-to-three coordinator. They have a health screening at the Menno School where children come for well child screenings. I got to meet the social worker’s children, and they were adorable! Afterward, I drove back to Freeman for a nice meal with my host family.
On Wednesday, I started the morning at the Bridgewater clinic, one of the other “rural medical clinics” owned by Freeman Regional. I noticed this morning that in a rural clinic, especially as a new provider, you are allowed much more time for a patient visit. I believe the patients really appreciate the time that providers spend acknowledging all of their concerns. We then went back to Freeman and spent the afternoon at the Salem Mennonite Assisted Living Home. They are very eager to inform visitors that they are the oldest assisted living home in the state of SD. We got some information from the DON and her assistant about a resident living in the home that felt he was ready to go onto living in an individual apartment. He came to the assisted living home due to his diabetic peripheral neuropathy, which was managed with better blood sugar control and pain relieving medication. The DON and her assistant were worried about his ability to care for himself on his own. They offered to allow him to come back to the home for meals, as they are more “diabetic-friendly” meals. They asked us for our assistance in determining whether he is ready to go home or if we had any ideas on what they could do to help prepare him to live individually. This is where my partner, Jenna, shined! She was able to figure out all of the things he would need – we decided to set alarms on his phone on when to take medications and when to check his blood sugars with notes of what to do with each alarm. He seemed to feel comfortable with this. This was a fun experience, and we also got to talk with a few of the other residents of the home. I then went home to enjoy a nice Schmeckfest meal of sausage and fried potatoes prepared by my host “mother,” Shirley. She is a great cook! We always have a good time at the dinner table. I should mention my host “father” is Dr. Ries, a retired physician of Freeman Regional Health Services. He is very modest about his accomplishments as a physician – he lets others do the bragging for him. I hear he was able to do a C-section in less than 4 minutes! He got plenty of practice during his mission work in Africa. Back to studying I go!
I forgot to mention — I went to the PT room in the morning to go for a run on the treadmill (it was a bit too chilly outside to run). I ended up running next to a nursing home resident who came to exercise on the nu-step. It was a fun time talking with him! This morning, we spent some time in social services. We went to care conferences at the nursing home. We had a centennial and two of her family members. Along with the resident, her family, Jenna and I, there was a nurse, a social worker, the activities director, and a dietary worker attending the conference. It was comforting to know the amount of roles that play in a nursing home resident’s well being. After the care conferences, I was pulled to the ER to care for a pediatric patient. Due to the small town (and everyone knowing that the helicopter came in for this), I will not disclose what the patient came in for. We called in the helicopter and the patient was taken to Sioux Falls. From this experience, I learned how sentimental it is to have your own family members and friends taking care of your family in the hospital or ER. While the nurses were trying to start an IV on this pediatric patient, and she was crying and squirming, we found out that the only thing that would calm her down was being sung to. The DON looked at her and sang to her until she calmed down. It was a very touching moment. There was another nurse that worked on the clinic side who was related to this patient who was able to take the rest of the day off to be with her family and take the patient’s mother to Sioux Falls. I don’t think that would happen if it didn’t happen in a rural community! We had a fun afternoon touring local businesses. We went to two greenhouses, two pharmacies, an old bank renovated to an antique shop, and Ruth’s husband, Dale’s attorney office. At once of the pharmacies, he even gave us a prescription (M&Ms) to show us how his big machine that was basically his pharmacy tech worked! We enjoyed eating our chocolate and spending the afternoon with the best tour guide, Ruth!
We are spending the first part of this week in social services. We have completed a few assessments on nursing home residents – PHQ-9 and BIMS. It is interesting to see how Lindsey asks the questions, as it seems more like a conversation than an interview. With Amanda, we went and talked with an inpatient and adult child about transferring to the nursing home. This patient currently lives with the child, who is a local farmer. The patient’s health has been declining and both parent and child realize that nursing home placement is the best option for them. We then sat in on a meeting held my Amanda, the social worker here. There was the DON of the nursing home, the CEO, the quality improvement staff member, the social workers, and Jenna and I present at the meeting. The meeting was held to improve the documentation process of behaviors in the nursing home. We definitely witnessed the many obstacles necessary to make a change like this in the nursing home. On our way out of the hospital, we were notified of a patient coming in via ambulance to the nursing home with potential stroke symptoms and seizure activity. Jenna and I ended up staying to “assist” the team. All of the staff members are very receptive to us. At one time, the patient began seizing, and Jenna stayed back. All of a sudden, she said, “the patient has been seizing for 45 seconds, I’m watching the clock.” The nurses were impressed with her! It is good practice to time a seizing episode, but sometimes, no one thinks to do it. I ended the night with a meal with Dennis and Shirley Ries where Dr. Ries discussed his history with transporting patients via helicopter back in his residency days.
We started this morning with a meeting at the hospital to discuss discharge planning and placement options for the three patients in the hospital. There are a ton of housing opportunities around the Freeman area. There are multiple assisted livings, independent livings, and nursing home facilities in Freeman and the surrounding communities. Even with the multiple options, it is sometimes difficult to place certain individuals where they want when it comes to nursing home versus assisted living and what town to reside in. We then went to a hospice consult with the hospice nurse at another facility. It was interesting to acknowledge the appointment and learning the questions that a hospice nurse asks. We then sat in on a Quality Improvement meeting for the nursing home. It was long, but informative and necessary. I now know how much work goes into making changes in a nursing home and the extensive amount of time it takes to make something happen. In the evening, I talked extensively with my host mother about her and her husband’s experience in Africa. They had two of their three children while living in Congo! Shirley is very kind, and she stated that she would never turn down an African family if they wanted food or clothing.
The next day we started with a provider’s meeting. The facility is working on a project that allows all patients with Medicare to have a free annual wellness visit. It was interesting to hear and see how they are integrating this into the normal clinical practice. After the provider’s meeting, we were heading to the clinic when we got word of a forearm laceration in the ER. We went to see the patient, who had struck a wrist with a knife while cutting some tape earlier in the morning. Dr. Hafiz let me suture the wound. We then sat in on a care conference talking with a patient’s spouse about advance directives and future care plans. The patient is an inpatient in the hospital, and the spouse and care team decided to go on with comfort measures. It was interesting to see the doctor, the nurse, the social worker, and the patient’s spouse come together to make a decision like this. In the afternoon, we went to a nearby colony for a tour. We had the preacher’s daughter giving us the tour along with a gentleman from the Freeman community. Their garden was absolutely unbelievable! We were able to tour the garden, the kitchen, the dining rooms, the church, and the outside of the school. We asked the preacher’s daughter, Brenda, multiple questions about her lifestyle and different things about the colony. If you ever get a chance to tour a colony, I would highly recommend it! We then came back to Freeman to see multiple exciting (to me) patients in the ER! We had one patient who had been walking and ran into a ladder with a large laceration on the top of the head. We got to staple the patient’s head. Then, we had a pediatric patient come in with a fishhook in the cheek! I got to assist in taking the fishhook out. We then spent the evening at Dale and Ruth’s with Jenna, Dennis, and Shirley for lasagna and great conversation!
After our blogs were posted last week, I discovered that my partner is a much better writer/blogger than I am. If you want a very detailed description of our experience here in Freeman, refer to Jenna Sorensen’s blog. 😉
This is our last week here in Freeman. The past 4 weeks have flown by! On Monday, we started the day in social services. We went to the inpatient part of the hospital to see a patient that had been admitted for pneumonia. We asked questions about the patient’s home life – how the patient bathes, cooks, and does other care. We then went along with a couple from Freeman to assist with Meals on Wheels. That afternoon, we were with Terri in the clinic. I helped Terri admit a patient to the hospital for hyponatremia. In the evening, Dennis, Shirley, and I ate our meal – which I should say I will definitely miss. Shirley is one of the best cooks ever! She is able to whip anything up from what she has in the house. She also has a garden, so she always has a salad with some type of vegetables from her garden. She told me the other night that they don’t eat out often, and I can clearly see why. I don’t think any restaurant can cook up a meal like she can! After dinner, I went out to their screened in back porch to study.
On Tuesday, Jenna is in class, so I spend the day in the clinic or ER. The morning started as a calm morning, until we were in seeing a patient at the clinic, and the nurse knocked on the door to tell us she needed us in the ER immediately. There was a patient that was having a potential stroke. The patient was well cared for and was flown out to Sioux Falls in a stable condition. That afternoon, we were at the Menno Olivet Care Center and Menno clinic. I ended up seeing a patient that I knew looked familiar, but I couldn’t discover why. It was when she began talking about her husband and told me that I had cared for him at a different rural clinic earlier in the experience that it clicked. I find that as an advantage of the rural clinics here. A provider can really get to know the patient, the patient’s family, and the patient’s home life just through two visits with different members of the family. In the evening, I came back to Freeman for dinner with Dennis and Shirley.
On Wednesday, we spent the morning with Terri in the clinic. It was a good morning, and Terri has been a fantastic preceptor and teacher to both of us along the way. She sat down with both of us and explained all of the different insulin pens used for diabetic patients. We then went out for lunch to the Prairie House with Ruth and Dale. In the afternoon, we spent some time with social services. We went to the Quality Improvement meeting. Again, it is evident how long the process is for a change to occur in a nursing home facility. They really have a great team approach at making changes here. In the evening, we had a meal with everyone at Dennis and Shirley’s. This was a special meal, not only because of the people we shared it with (Dale, Ruth, and Jenna), but because we were served cheese pockets, a delicious food served every year at Schmeckfest. It was a fun night with a great meal and even better company! We sat on the deck and talked until the sun went down (which in the summer indicates it’s usually past my bedtime).
On Thursday, I spent the morning with the cardiologist that comes here as an outreach clinic from North Central Heart in Sioux Falls. He was very thorough, and I learned a lot about the cardiac physical exam. During lunch, Jenna and I presented on HPV vaccination and our experience over the past 4 weeks to almost 30 people from the hospital and community. The audience brought quite a few questions, and I was glad to have Dr. Kirton at the presentation to answer a few questions that I was unable to answer. We then sat in on a hospital staff meeting where they discussed how they could improve the ER and hospital setting. Everything is very patient-driven here, which is how a hospital and clinic should run! After the meeting and presentation, Jenna and I sat down with a few staff members from FRHS to discuss our time: what we thought went well and what we thought we could have done without. I have had a very positive experience here in Freeman, and I hope they continue to work with the REHPS program so that other students can experience the hard working, community and patient driven facility that we have over 4 short weeks.
On our last day, we started in the PT department for cardiac rehab. It was fun to get to know the patients and their cardiac history. We learned about a certain family that has had an inherited genetic disorder throughout their family. Unfortunately, this variant caused one of the family members to pass away from sudden cardiac death at a young age while running a marathon. It is called ARVC – Arrhythmogenic Right Ventricular Cardiomyopathy. In non-medical terms, this condition is when a patient exercises or stresses the heart, which causes the heart muscle fibers to stretch (this is normal and healthy), but the heart muscle fibers that should grow back together, are actually replaced by fatty, non-muscle tissue. This is a very simplified definition of this condition. I would encourage you to look it up and learn some about it – as you could save someone’s life someday! I’ve learned throughout my “PA school career” that if you don’t know a diagnosis, you will never look for it. Even though this disease is very rare and usually only present in some families, it is good to know, especially for this community! Over lunch, we were interviewed by Freeman’s newspaper, called the Courier. Keep your eye out for an article about our experience!
I will wrap this up by saying that I have had a wonderful experience here in Freeman. I always felt that I was welcome anywhere in the facility at any time and my opinion/medical diagnosis or treatment was trusted. There are multiple people that made this experience great. I have to give a huge thanks to Dennis and Shirley Ries, my hosts over the past 4 weeks. Dale and Ruth Strausser, Jenna’s hosts, were also very welcoming. This community and FRHS is full of very motivated individuals that are constantly trying to improve their home community and facility! Thank you to everyone!!