Austin Eggers on his time in Sisseton
Hi, my name is Austin Eggers. My hometown is Rosholt, SD, a short drive from my REHPS site of Sisseton. I recently finished my first year of med school at USD, and I’m very excited to spend four weeks in Sisseton for REHPS! There are many familiar faces here, as I spent a few years shadowing in the clinic in the past and also worked as an EMT in Sisseton in that time frame as well.
I spent my first day with Dr. Morales, a general surgeon. We spent the morning in the clinic. It was interesting to see Dr. Morales guide questions to his patients to begin to make a diagnosis. I could clearly see why he was asking questions in the order he was asking them, something I wasn’t able to do when I began shadowing in undergrad. We spent the afternoon in the OR, where I saw a foreign object removal from the stomach and was first assist on right buttock debridement. I even got to help remove some necrotic skin and use the cauterizer!
My second day was spent with Dr. Johnston (ortho) in the morning and Dr. Meadows (family practice) in the afternoon. As a big sports fan, I am interested in musculoskeletal injuries, which Dr. Johnston sees often. Dr. Meadows did a great job of using analogies to explain different pathologies, which I appreciated. Late in the day, Dr. Meadows was called to the ER for a patient with a ruptured varicose vein, which I was able to see. Shortly after, Dr. Peterson and Dr. Beumer did a C section in the OR, which Adam and I were able to scrub in on. I was able to use equipment to keep the fascia and musculature back for Dr. Peterson and Dr. Beumer and also cut excess suture from Dr. Peterson’s sutures during closing. Overnight, Adam and I came to the hospital for a vaginal delivery. This was the first vaginal delivery I had ever witnessed. Watching life come into the world is an unforgettable experience! Unfortunately, the baby was having a hard time clearing it’s lungs and working really hard to breathe. The baby was transferred by helicopter to Fargo late in the night.
I spent Friday with Angie Gaikowski, a nurse practitioner. We spent the day in the clinic seeing a variety of patients, including those with sinus infections, neck pain post vertebral fusion surgery, hypothyroidism, and cardiac murmurs and bruits. Something important I picked up from Angie was to not be afraid to talk to colleagues if you have a question about a patient’s condition. Angie knows a lot, but wanted to make sure she was right by asking other practitioners and physicians if she was not entirely certain in a situation.
Adam and I started off Saturday by helping out at the Relay for Life in Sisseton. We helped set up and sold baked goods for the hospital booth. We also checked out the car show in town and went out to Fort Sisseton for Fort Sisseton Days. We also went trap shooting one night and went to Mass at St. Peter’s this week. It was an interesting and exciting first week, both inside and outside CDP!
Monday was a day in the ER with Dr. Beumer. I had spent a number of days shadowing Dr. Beumer in undergrad, so it was nice to be back with someone who strengthened my desire to become a physician. It was a very busy day in the ER. Two patients stuck out to me. One had right lower quadrant pain which intensified with rebound tenderness, which typically means appendicitis. However, after lab tests and imaging, it turned out the patient more likely had either PID or an ovarian cyst. This showed me that it’s important to put the whole picture together instead of jumping to conclusions quickly. Another patient came in with late stage COPD and was having a very difficult time breathing. It was quite the change of pace to see our COPD patient and then do a newborn check on a baby that was born today.
Tuesday was another day in the ER, for the most part. It was a much quieter day than Monday was. Our patient with end stage COPD had improved and was actually able to move over to the hospital wing today. Since the ER was pretty quiet, Adam and I went down to the pharmacy, and he taught me how to fill the Pyxis machines. We were back in the ER again in the afternoon with Dr. T. She does an excellent job explaining her thought process for each patient, which I find extremely helpful to guide my thought process. Once we were done at the hospital and ER for the day, Adam and I went down to Agency Village to work out at the reservation wellness center and we also went trap shooting at night with Chris, the CRNA at CDP, and Dr. Riley, one of the OBs.
Wednesday was my third day in the ER. Today I got to follow Nate, a CNP. Nate was awesome at explaining lab values/tests and treatment plans and always asked me what I was thinking on our couple cases. I was able to do a history by myself for the two patients we had. The one I spent the most time with was a lady who had lost a lot of weight recently on the Sanford Profile diet plan. We believe she came in because she was too hypoglycemic and almost starving herself by taking in too few calories during the day. In the afternoon, I followed Dr. Lanctin, a urologist on outreach from Watertown. Dr. Lanctin connected well with his patients and always had something to say to make them smile, even though he might not have known some of them as well as a primary care physician might. He even had me feel the prostate on one of his patients. Adam and I went to Eden for their infamous wing night, which I had previously known was awesome.
Jackie Bartlett, PA, was my mentor for Thursday. I was able to go in and do histories and some physical exams for Jackie’s patients. It was great to be able to work on these skills, and I was getting more and more comfortable doing them throughout the day. Jackie does family practice, so I saw a wide range of patients, all the way from a five-month-old baby with a rash to a 91-year-old with flank and abdominal pain. Jackie would ask me what I thought might be going on with patients and was always happy to answer any questions I had.
I spent Friday with Dr. Gallagher. He has been a practicing family physician for the last 40 years in the Sisseton area, including Wheaton and Herman MN, Sisseton, and my hometown of Rosholt. Dr. Gallagher goes the extra mile with his patients. He personally calls his patients with lab results (even late at night) and shows his patients their own x rays. He drew a cartoon diagram of the heart to explain to one of his patients what their condition was. There was a girl who slammed her fingernail in a door this afternoon. He put in the extra time to drain this girl’s fingernail on a Friday afternoon at 5 pm so she didn’t have to go to the ER or wait until Monday to see someone else in the clinic. Today I definitely learned how to treat patients well. I can tell that Dr. Gallagher has been around for his patients whenever they need him, whether it’s Friday at 9 am or 6 pm or the middle of the night during the weekend. I will keep this in mind and incorporate this in my future practice.
Tekakwitha Living Center had a fundraiser golf tournament in Sisseton on Saturday that I participated in with a couple friends from Rosholt. Dr. Meadows and Dr. T sponsored our team, which included 18 holes of golf, three balls, a glove, golf carts, and a steak dinner all for free! We were all very thankful we had the opportunity to do this. Although it was quite windy to start, it turned out to be a beautiful day. It doesn’t seem possible that our time in Sisseton is half over already! I’m looking forward to the last two weeks here.
Monday began with cardiac rehab. Nicole showed me the ins and outs of what she does in cardiac rehab every day. Most of the patients have been referred to cardiac rehab by either their primary care physician or cardiologist after they have a stent passed or have undergone bypass surgery. Most of these patients have seen great improvement during their time in cardiac rehab, and many keep coming back to the hospital to walk or lift weights after their “prescribed” time is finished. I spent the rest of the morning with Dr. Riley, an OB. He did not have any patients this morning, but talked about the future of health care with me. I spent the afternoon with Dr. Peterson, another OB. She is a very good educator, for both the patients and myself. She explains concepts in a relatable way to her patients, similar to Dr. Gallagher last week. She also taught me to use Leopold maneuvers to locate the fundus on her patients and where to listen for a heartbeat, which I was successful on finding a couple times!
The first big thing I saw on Tuesday was a patient in the ER affected in a car accident. The patient was heading back to Kansas City from Grand Forks and a deer crossed their path, shattered the windshield, and ended up in the backseat of the car. The ambulance brought the patient in, and luckily, the paitient only had a few lacerations on the face and knuckles and some glass from the windshield in the right eye. Dr. T flushed the eye and shined a fluorescent light in it, revealing some corneal abrasions which were not serious. In the afternoon, Dr. Meadows had an 11-year-old who presented with classic symptoms of appendicitis. After undergoing a CT of the chest, Dr. Meadows didn’t believe the patient had appendicitis by the imaging, and Dr. Morales, the surgeon, agreed. This showed me that sometimes classic symptoms can lead you astray, and more information is needed in certain situations. Adam and I also saw two very different ends of the spectrum overnight: another birth and a depression/suicide attempt.
Wednesday started early with a cholecystectomy (gall bladder removal) with Dr. Morales at 8 am. Dr. Morales was testing my memory of anatomy, and I also was able to be first assist and run some cameras and place the excised gall bladder in a receptacle to take it out of the body. I was also able to see Chris, the nurse anesthetist, perform a steroid injection into a patient’s back. Chris is great at explaining what he is doing to his patient and myself, and he is a very calming influence on his patients as well. Adam and I spent the afternoon in the ER. We saw a number of interesting cases, including a radioulnar fracture in a young patient and a fishhook extraction from an older patient’s ear. Adam and I helped Nate splint the child after Nate had reduced the fracture, and I was able to use a pliers to snap some parts of the fishhook when Nate directed me.
I spent Thursday with Dr. Peterson, an OB/GYN. The first patient of the day was an older woman who had some hip pain. This wasn’t what I expected to see when I was with an OB/GYN, but it showed me that OB/GYNs see more variety than I thought they did. One of the patients in the morning was having some abdominal pain. She knew she was pregnant, but Dr. Peterson wanted to make sure she didn’t have an ectopic pregnancy. Dr. Peterson explained to me that sometimes women will feel pressure in the lower abdomen when the uterus begins moving/growing, which ordinarily happens at this woman’s stage of pregnancy. We also had a patient come into the ER who is 36 weeks pregnant, and her symptoms coincided with the baby’s head beginning to move down towards the cervix. I appreciated how Dr. Peterson can explain medical situations in a way that both her patients and I can understand, and I also appreciated her sense of humor. Chris, the CRNA at CDP, took Adam and me to wing night in Beardsley, which we really appreciated. Chris, along with many others, has gone out of his way to really make Adam and I feel part of the community. Dave, Adam’s uncle, also took us out for drinks at Rosalie’s, one of the bars in town.
On Friday Adam and I were able to see different areas of the hospital that a physician probably doesn’t spend much time. It was nice to see how all the parts of the hospital work together. April talked to us about QI and patient response to provider/physician care, which is an increasingly larger component of the pay for performance model healthcare is moving towards instead of the pay for quantity of procedures or patients. Vanessa did an excellent job of explaining all the different tests they run in the lab. Collette explained to us what respiratory therapists do and the difficulties small hospitals face in using respiratory therapies, such as keeping all staff trained to do procedures that might only be seen in Sisseton three times a year. Tanya showed us radiography and some of the interesting pathologies that have come through Sisseton in the past. Adam and I also went to IHS today for a First 1000 Day Initiative. There was recently a study done for the Sisseton Wahpeton Oyate Tribe that monitored strengths and weaknesses of mothers, fathers, and infants on the reservation. The hope is that this study will be able to reinforce some of the good things that Native Americans on this reservation are doing for pre- and postnatal care and some of the things that can be improved. I thought it was awesome that there were so many people at this meeting. There are many passionate people in both word and action trying to improve life on the reservation, whether it be prenatal care, maintaining a community garden, running a blood drive, or doing car seat safety tests. I brought Adam home on Friday night so he could experience what life is like in Rosholt.
We only have one week left in Sisseton! Time has flown by, and I’m excited to see what next week brings!
I started my Monday morning with home health. Monday is one of their busier days, and there were a lot of phone calls to be made. The three nurses had a meeting to talk about patients of the previous week and also to plan out the rest of the week and delegate who has which patients for the week. I went on three home visits. This reminded me a lot of my past experiences working with the ambulance, except that these weren’t emergencies. Jessi, the nurse I was with, did some similar things I did when I was on the ambulance on the visits, such as vitals (blood pressure, pulse, pulse oximeter). We saw a double amputee, a patient who needed help organizing meds, and a patient with renal issues who has a lot of physical difficulty leaving the house. I spent the afternoon with speech therapy and physical therapy. There was a patient who was recently in a car accident in speech therapy. The patient suffered a second concussion in a short period of time, and it was interesting to see the different exercises the therapist put the patient through. So many patients in the clinic get referred to physical therapy, and it was neat to see how physical therapy really works. Bridgitte, the therapist I followed, noted how much the patients were progressing from one week to the next.
Adam and I began Tuesday with a tour of the IHS facility in Sisseton. I had been there previously with the ambulance to transport patients to either CDP or Sanford Fargo, but I hadn’t seen the whole facility until Tuesday. We were given in depth tours of the pharmacy, dental clinic, and medical clinic, and there is also a large lab, eye care center, and dialysis unit as well. IHS in Sisseton does not have an ER, so patients must go to CDP after hours (7/8 pm) to receive care if they need it. I spent the rest of the morning with Dr. Morales, the in-house general surgeon. There were many black streamers and black balloons in his office, which led me to believe Dr. Morales was celebrating a milestone birthday (it was indeed his 50th). There were no procedures to see this morning, but I was able to see some of the patients I had previously seen in the OR. It was nice to see this continuity of care, rather than only seeing the patient when they are under anesthesia in the OR. Adam and I also did our community project this afternoon. We presented on “Summertime First Aid” to 4H kids at the 4H grounds. Topics we talked about included nosebleed treatment and sunscreen and bug spray application. We also talked about what doctors and pharmacists do and how long we have to go to school, which I hope didn’t scare any of the kids. Unfortunately, the kids knew more about SDSU than USD, but I did my best to educate them (Go Yotes!).
Leslie, the HR director at CDP, lined up her sister’s lake cabin on Clear Lake for Adam and I for the last week we are spending in Sisseton. It is awesome! Kayaking on the lake is a blast, and Tuesday the lake looked like glass, making it a perfect kayaking day. We had a picturesque view of the lake from the cabin and the most beautiful skies for star gazing overnight here. I don’t think I’ve ever seen more stars in my life than what we have seen for two clear nights here. We are very thankful that Leslie, her sister, and CDP arranged for this to happen!
My last full day in Sisseton began with Dr. Kamlitz, a general surgeon on outreach from Prairie Lakes in Watertown. We began with an EGD and colonoscopy on the same patient. Dr. Kamlitz had me feel the patient’s hemorrhoids and do a rectal exam on the patient before the colonoscopy. The patient also had a torus (abnormal bone-like formation on the roof of the mouth) that Chris pointed out to me. I was able to see another EGD this morning and then followed Dr. Kamlitz in the clinic for the rest of the morning. Leslie took Adam and I out to Hickory Street Grille for lunch, which had really good pizza. I spent the afternoon with Dr. Gallagher. I spent a day with him two weeks ago and was very impressed with how he treats his patients, and it was a very similar experience today. Storms were going through the area later in the day, but cleared up enough for us to go kayaking and watch a gorgeous sunset on the lake.
Our final day concluded with Adam and I giving our presentation of the four weeks to our families and staff at CDP. I am very grateful to everyone who made my REHPS experience so outstanding. Thank you to the state of South Dakota for providing the funding to allow others like myself to do REHPS. Thank you to Cheri and the Yankton AHEC for choosing me to be in the program, placing me in Sisseton, and Cheri for being so helpful the past few months. Thank you to all of the providers who were such great preceptors. Thank you to the nursing staff and all other employees for making us feel welcome and helping us out when we needed it. Thank you to the kitchen for making me food (which was always good), whether it was breakfast, noon, or night. Thank you to Leslie and Michaela for organizing everything for us and setting up a great schedule. Thanks to Leslie also for renting out her sister’s cabin on Clear Lake and her sister’s family for allowing us to spend time out there. Thank you to Adam’s family, especially his Grandma Noreen, for all the meals and letting us watch the NBA Finals at her house, and also Dave, Sharon, and Greg for making our experience great. I couldn’t have asked for a better partner in crime than Adam for the past month. He made this experience so much fun, both inside and outside CDP. I hope many students apply to this awesome program in the future!