Joe Turner on his time in Martin
This first week in Martin has so far been a very hands-on experience. Tyler and I have gotten a lot of experience with taking patient histories, assessing the patient, and coming up with a treatment plan that we present to the PA or CNP working the case. Working in the Emergency Department has been a particularly exciting part of this program. This isn’t the most heavily populated of areas, so the ED isn’t extremely busy. However, they get their fair share of emergencies and interesting emergencies at that.
We had a code come in the first day. It was a smooth transition from the ambulance crew to the staff working in the ED. The PA on call explained to us that she liked to keep the room calm so that it would continue to run smoothly. This was very evident during the code, and it contributed to the confidence and communication in the room. Tyler and I were not actively involved in this code, but I feel confident that I would be able to be an effective team member with the calm nature of the ED established by the PA.
The medical staff called us in, invited us to be a part of the process, carefully walked us through the process, and answered all our questions afterward. This set the tone for the first week of the program. We followed several providers who all followed the same trend during the first week. I attribute much of the willingness to help by the staff and the patients to the rural community of Martin.
An individual came in with severe trauma requiring immediate intervention. We were called in shortly before the ambulance showed up and helped to prep the ER for the incoming patient. We went over all the equipment in the ER in detail earlier that day, so equipment and procedures were fairly fresh in our minds.
There seems to be a pattern where if somebody mentions a condition or learns a procedure, it will come in later. Another trend is that these emergencies come in waves. It’ll be quiet for some time then be swamped for hours after that. This emergency was the beginning of a new wave of emergencies for the evening, and the first responders stressed the urgency of the case coming into the ER. The patient came in and the room was filled with staff doing their job and treating the individual. We eventually had to fly the patient out to be treated elsewhere.
An interesting point that I drew from this experience is just earlier with the same provider, we were calmly visiting with an elderly patient about their weekend and grandkids. This was a fascinating sight, seeing the provider go from small town doc to directing an ER in a bad trauma setting. This may happen to some extent in a larger care facility in a larger city, but it is commonplace here.
After spending plenty of time in the clinic and the ER during this past week, I have taken several histories from patients. This is not really a big deal and is a very routine process, but the information revealed by patients shows the trust that they have in the provider. They trust me not because they know me or because I’m sporting the Cardio IV stethoscope and holding a clipboard but because they have faith that my intentions are to hear their story without judgement to help them.
This divulgence of information does largely depend on the patient and their personality type. Some people will tell anyone on the street about their problems, but most aren’t as willing to share. Much of this comes from how I ask them about a sensitive topic. Even without meaning to, I can sound judgmental when asking about something like drug use or getting a social history, so this is something I had to practice. Even in the ER, patients will shut down or look to someone else if they sense you judging them, which is entirely understandable. However, the ER is not a place to start holding secrets, especially if pertinent to their condition.
Some patients are already closed off before being asked about their history. This may be due to them being ashamed of themselves or having had people looking down on them in a healthcare setting before. The providers here at Bennett County are great to observe how they establish a relationship with the patient both as a provider and somebody that cares about their patient’s wellbeing. I’ve picked up on a few key phrases and body language tips, but more importantly, I’ve learned that you don’t have to act like you care if you do care.
This final week of the program was highlighted by an event early in the week. A storm was rolling in and the ER was quite busy this evening. A patient came in needing OB services, so we prepared the labor room. The labor room back near the ER can be used for a delivery, but the providers explained to us earlier in the program that it was mostly meant for emergency deliveries. Most deliveries are sent up to Rapid City or another facility, but the providers are able to perform these services in Martin.
The storm worsened after this patient came to the ER, so it didn’t look like we were going to be able to get an ambulance to go to Rapid City. A brief time later, all our phones went off indicating a tornado warning for the area. All the hospital patients were brought to the hallway in preparation for severe weather.
Most of the time, emergent patients are treated in Martin, stabilized and flown out to a larger hospital where they can be further treated. There are fixed wing and helicopter methods of transportation to get patients to the larger hospitals, but the weather was far too severe to transport anyone in either of these ways. The providers also explained this sort of situation to us earlier in the program. They are somewhat isolated out in Bennett county, but they are especially isolated during times like this.
The storm did pass both literally and metaphorically with the emergent situation panning out and finding an ambulance crew. The staff remained incredibly calm and collected during this hectic time with the severe weather and other patients in the ER needing care.
I was very impressed by the staff able to handle these situations with the closest large hospital being an hour away by flight and ever further by vehicle. This situation very well displayed rural and frontier medicine.