Tia Chase on her time in Philip
Now I am not the greatest of writers so please bear with me as I blog my time in Philip! Today is our first full day in Philip. My partner and I traveled yesterday to get settled in so we are both very excited to see what the town has in store for us. We started our morning being greeted around the hospital by the friendly staff and getting acquainted with the clinic and hospital. Next, our guide took us on a tour of the town and showed us what places to visit during our time here! For lunch, the hospital was throwing a barbeque to welcome us to the facility. Burgers and brats were delish, plus many desserts to chose from including a summer favorite – Root beer floats!
The afternoon we got our first taste of what our disciplines would hold for us during our time here. As a PA student, I went with my preceptor Terry, the PA at Philip Health Services, and shadowed him in the clinic for the afternoon. The first patient we had came in with known osteoarthritis to the knees, and I was given the opportunity to give a joint injection! I have previously done an orthopedic rotation so it was fun to be able to practice what I had been taught especially on the first day in Philip! Since the clinic flow was slower, we went to check out if the hospital had any IVs to start so I could get some practice in, but we were unsuccessful. They had just started the only IV for the afternoon unless an ER arrived. Well luckily enough Terry volunteered to be a mock patient, and I was able to practice starting the IV on him. I can already tell this will be good rotation!
Today Rebecca and I got to hang with the radiology staff and the orthopedic surgeon from Rapid City who does outreach every other Tuesday in Philip. I was excited for this day as I extremely enjoyed my orthopedic rotation. For the morning, I started following Dr. Duchene and his assistant. Our morning consisted of post-op follow-ups. I enjoyed chatting with Dr. Duchene on the approaches he takes with his surgeries to compare to what I had witness in my prior rotation.
After lunch at Subway, Rebecca and I switched positions. I got the opportunity to see the radiology side of the outreach day. I witnessed the various positions they placed the patient in to get the views they needed which was great since I’m a visual learner. I was able to think through the anatomy that would be highlighted in that specific view. I really appreciated being shown their protocols for that specific radiology department. As a future provider who would be ordering many images, it was nice being told what views a radiologist would prefer in particular settings.
We started out our morning with Home Health today. Neither one of us had prior exposure to what home health nurses provide for a community so we spent the first part of the morning just listening to all the services they can provide. It is amazing how much they can do for a patient and how independent it allows the patient to remain with this extra help! After they answered all our questions, two of the nurses got permission to bring us along to the home visits. I got the opportunity to meet a patient who has turned their world completely around after being diagnosed with diabetes. The patient was generous enough to tell me their story that led up to the diagnosis and I can tell you that the patient has come a long ways! I thoroughly enjoyed seeing the partnership that the patient has developed with the home nurse, and it really is crucial to helping the patient stay on track of their health. I love seeing how these organizations that providers encourage patients to reach out to benefit the patients, and what better than to personally experience this home visit encounter!
For lunch we decided to try the local Pizza, etc! here in town. This place has so many options to choose from that we spent at least 10 minutes trying to decide what we wanted! I finally chose mini corn dogs and tater-tots for a treat! They were delicious!
After lunch, we made our way to the courthouse to meet with the Community Health Nurse Heidi. I have heard of the names of the services she provides for the surrounding area, but I had not had the opportunity to be explained what those services really provide. She spent at least a couple of hours educating us on the WIC program, Family Planning program, and immunizations. I enjoyed being able to ask questions to understand what the programs do and do not provide for the patients as I will be referring patients to these programs in the near future as a PA. I do not think I would have gotten this type of experience if it wasn’t for REHPS.
Today Rebecca and I got to spend the day in the clinic with Terry Henrie, PA-C. The first patient we saw was a child seen for mattery eyes. After we first assessed the patient, we decided to test for strep throat. Luckily Terry didn’t make either one of us make the child mad by swabbing the child’s throat! J We then followed the sample into the lab and saw how a rapid strep test was done. We got the privilege of telling Terry that the test came back positive, and we discussed the treatment options. We got our first look at the ER during the morning with a patient presenting with COPD exacerbation. We watched Terry work up the patient and got to follow the patient along to the CT scanner after the plain chest film showed a questionable nodule. This was the first time I got to witness how the radiology department performs a contrast CT scan. To end the clinic day, Terry gave me the opportunity to perform cryotherapy with liquid nitrogen on a wart on a patient’s finger. It may seem simple, but I love performing these fun easy procedures in the clinic setting! Being in a rural clinic allows me many more opportunities especially when patients are open to allowing a student perform them!
Tonight, we had finally sat down to do some studying, and I received a text about a good ER case that just arrived. Since we are staying with an awesome host whom only lives a block from the hospital, we decided to stop being productive and head to the ER to see what was happening. When we got there, the nurses and Dr. Homan were trying to get IVs started on an elderly patient who appeared in great pain. They were busy working and trying to get the patient ready to be sent for imaging when the patient lost consciousness suddenly. They immediately recognized it and prepared for a code situation. At this point, things were becoming more stressful in the ER, and Rebecca and I tried lending our hand whenever it was needed! I was impressed by how the team worked together throughout the whole situation to provide the best care to the patient. I was most impressed by how they regrouped after to go through what they thought went well and what they could improve on the next time they were greeted with a similar situation. This showed me how crucial quality teamwork is in any medical situation especially in the ER setting.
Today was the last day of our first week, and I think it was good that it was a slower day in the clinic. We had many exciting and interesting things happen in our first week that we had a great conversation with Terry during our down time in the clinic to discuss what we had witnessed throughout the week. He loves to teach and I appreciate how open he is to any question we have. What is especially great is how eager he is to point us in the right direction if he cannot give us the correct answer! We did get to watch him suture a laceration on the hand today! I hope to get a chance at a laceration during my time here as I love learning each provider’s tips and tricks to add to my own!
I would say this was a great first week to start the REHPS program! I do not know if I will be able to stay up with blogging each day, but I will do my best! Philip has already shown how great their community is! We have felt welcomed from the get go! Bring on week two and the exciting events that may be awaiting us!
My second week started on Tuesday since I had a personal commitment on Monday. Our Tuesday started off in the clinic following the providers into their patient encounters for a couple hours. For the rest of the day we got to spend with Dr. Scarborough, an optometrist from Rapid City who comes every Tuesday to Philip. He spent a good majority of his free time answering all of our questions plus showing us the interesting machines he uses on a daily basis.
Wednesday we spent the day in the clinic following Terry Henrie, PA-C, and Janell Gerberding, PA-C. We got to spend some time follow Janell into the Philip nursing home to examine a couple pressure ulcers while the wound care nurse took care of the dressings.
Thursday we spent the morning with Dr. Holman in the Philip clinic. Since he was on call for the ER, we were able to visit with and exam a patient with an ankle injury before leaving for Kadoka for the afternoon. While in Kadoka we were able to visit a few of the residents in the nursing home facility as well as a few patient visits in the clinic.
Friday consisted of clinic time with Dr. Blackham. During the afternoon, I got an opportunity to debride a pressure ulcer with the help of Becca so that was a fun way to end our week 2! We really appreciate all the time the providers spend explaining to us their rationales for treatment as well as discussing past cases that are too interesting not to share to eager students!
Over the past weekend, I had stayed in Philip and took call. Even though it was uneventful (bummer for me, but not for the patients which I’m glad!), I got the opportunity to dog sit for Terry while his family was gone on vacation! It was fun just experiencing the town on a weekend!
To begin my 3rd week in Philip, I traveled to Kadoka with Terry to do a full day in the Kadoka clinic and nursing home. Since it was the day before the 4th of July, our schedule was fairly open. We got to round on a couple patients in the nursing home as well as see a few patients in the clinic. The best one was flushing out impacted cerumen (wax) from a young gentleman’s ear!
After the holiday, both Becca and I spent another day in the clinic with Terry, but this time it was in Philip. We saw a large variety of patients. Becca and I both got to perform cryotherapy (liquid nitrogen application) to a patient’s precancerous lesions on his face and scalp. I have been able to apply liquid nitrogen prior to this rotation, but this time it was fun doing it alongside Becca! Luckily, the guy was tough as nails and could handle two people doing it at the same time.
Thursday, Becca and I spent the morning at the Philip assisted living center known as Silverleaf. We got to meet the friendly staff and tour the facility. They were extremely welcoming and the residents were sweethearts! I enjoyed spending time with the manager as well as the registered nurse throughout the morning. Both were gracious enough to take the time to explain how the center operates and how they have evolved over the years! I love experiencing how a small community blossoms with everyone’s help!
To end my 3rd week in Philip, I spent the day with Terry in the Philip clinic. We discussed multiple cases and he is always so willing to answer all of my endless questions. However, the most exciting part was sneaking away from the clinic with Becca and Terry for just a few minutes to learn how to shoot a bow! If that isn’t rural, I don’t know what is!
I can’t believe that our last week is approaching already, but I look forward to seeing what exciting events it holds for us!
Our last week in Philip started off with a new experience for me! We got to spend the day in the lab. I loved the chance to learn about the various tests that I will be ordering as a provider. This provided me great insight in how long to expect for tests to be ran and completed from draw until results. Hopefully I can be a better coworker and appreciative of the lab techs I will be working with in the near future!
We also got to spend more time with Dr. Holman in the Philip clinic. He was more than willing to let us freeze off a wart and some actinic keratosis on a couple patients. We also saw an interesting case of jaw pain in an elderly woman. She has been through many tests to try to find the origin, but nothing seems to be providing answers. Becca and I got to see how Dr. Holman reached out to the local dentist to see if we have missed anything in her extensive workup. This shows how easy it really is to use our local resources for the best care possible for our patients.
Wednesday we got to spend a day outside of the hospital environment by observing the local pharmacy, Dakota Country Pharmacy. Courtney, the pharmacist and owner, was so fun to listen to explain how their day-to-day operations run. Neither one of us had been behind the counter so we appreciated seeing how much detail goes into each prescription to provide the patient with the accurate drug.
Thursday morning we spent with Dr. Holman in the Philip clinic prior to our lunch presentation. Cheri provided all of us with some great Subway for lunch while Becca and I gave our final presentation of our time here in Philip! I was glad Becca decided to stick around until Friday with me since I would have to get in hours for my PA program. We got the privilege to follow Dr. Holman in the Kadoka clinic and care facility for the afternoon.
For our last day we spent our remaining time in the clinic with Dr. Holman in Philip. I just want to say how grateful I am for this program and the wonderful facility that provided a great REHPS experience! I am sad that this is my final rotation, but I am so excited to begin my career as a PA soon! Philip and its providers have definitely helped provide me with the confidence needed as I transition to actually practicing medicine. Thank you Philip Health Services, REHPS, Yankton AHEC, and USD PA program for allowing me this opportunity!