March 21, 2018

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Rural Healthcare in Action: My Two Weeks in Granite Falls

Lily WoodMedical student, Lily Wood, spent two weeks with us for her  Summer Institute for Medical Student (SIMS) experience. This is her reflection on the time she spent at ACMC-Granite Falls. 

“I arrived in Granite Falls, Minnesota after a 2.5 hour drive, mostly through corn fields and teeny towns, at the end of July. I was nervous. After all, I would be staying with Dr. Arthur Rillo – one of my preceptors for my Summer Internship in Medicine (SIM), and his family. I pulled into the driveway of a beautiful home on a quiet street overlooking the town of Granite Falls and the Minnesota River and made my way up to the front door.

I was greeted by Dr. Rillo, his wife, Billie, and their youngest child, Nicole. We sat by the pool and I got a quick introduction to ACMC, the medical organization that employs the doctors in town and coordinates SIM, the Granite Falls Municipal Hospital, and life in the town itself. I felt myself relax into the cushions of the outdoor sectional – I felt at home and excited to get started.

The weeks were a blur of activity! On my first day I met with Darlene, who planned my daily schedule with Alissa Gallinger, the coordinator for student summer interns at ACMC headquarters in Wilmar (45 minutes northeast). Thanks to these two women, I had busy days with plenty of variation and excellent organization. Every preceptor I worked with knew when I was coming and had prepared to make my experience with them the best it could be. There was never a dull moment!

My activities included spending time in the ACMC family medicine clinic with all the family doctors (Drs Rillo, Eakes, Pietka and Carter – who won best family medicine physician in the country in part for his work on the CALS initiative), time in the OR with Dr. Bell (a dynamic and fun general surgeon who jumps into the OR first thing in the morning and asks, “who’s excited for some colonoscopies?”), time with Jim Nedrud at Project Turnabout (a rehabilitation center for alcohol, drugs and gambling), time in the radiology department (you get some crazy accidents due to ATVs and livestock), time in the lab (thanks to Dean for blood typing me!), time with the EMTs in the ambulance on calls or in the ambulance garage (some of the best people! Funny, tough and extremely efficient, knowledgeable and adept at functioning under pressure) and time in the emergency department in high and low pressure situations with many different people (including Fred, PA, who challenged me to take the lead on a couple of patients my last night in town and gave the best cardiovascular physiology explanation ever).

On a number of occasions, I was given the opportunity to see patients on my own and even do some small procedures including suturing a skin biopsy site, removing and cauterizing skin tags, irrigating a lady’s ears to remove cerumen, and more! My comfort with patient interviewing and performing physical examinations increased by leaps and bounds thanks to the efforts of preceptors, staff and patients who welcomed and worked with me to build on ECM skills learned during Year 1 of medical school.

One of the highlights of SIM was witnessing the births of two babies. I have never seen anything quite as miraculous as a new human coming into the world! One of the babies arrived at 3 AM on Monday during my second week. I held one of Mom’s legs as she pushed – 10 minutes or so later a beautiful girl was born. Dr. Rillo suctioned her little mouth and nose and then Katie and I swaddled her and took her to the incubator to be cleaned, measured and poked with her first shots. It was 4 AM when I got home that night but totally worth it! Holding the baby and visiting with her family the next day I was again struck by the incredible event I had witnessed. And what a joy for the whole hospital! When other nurses and staff heard the news they smiled and were delighted.

I spent most of my time in the hospital – either in the family medicine clinic or in the ED. I did find time to spend with the Rillos – dining at a winery, running the Olivia 5-miler at the town’s corn festival, baking brownies with their daughter, eating popcorn at the famous stand in town and hanging out in their living room. I also took myself on a couple trips. I visited the Upper Sioux Recreation Area (park for $7/day, or rent a campsite or teepee!) and ran the trails. I also enjoyed running Billie Rillo’s favorite trail through the town cemetery and walking to and from the hospital for my internship. A recreation center in town (Kilowatt) is also free for hospital staff and has an exercise room and a pool. There’s plenty to do in the area and I was never bored! I hope to return next year for Western Fest in Granite Falls and the powwow hosted by the Upper Sioux Nation.

At first I was caught off guard by the friendliness of Granite Falls residents. Why is everyone waiving at me? I thought as I walked to the hospital on my first day. It only took one afternoon meeting the hospital staff and patients to realize there was nothing weird going on – everyone around here is genuinely nice and welcoming. I got accustomed to waiving back at cars that drove by, to exchanging pleasantries with all the hospital staff and was never denied a visit with a patient. In fact, more often than not, patients seemed delighted to meet a student and contribute to my education. The physicians, nurses, techs and EMTs, too, were eager to teach and answer my questions. More than once I gave out my phone number so that the staff could call me if “anything interesting” happened. I got so close to the people and in a rhythm that it was hard to leave my last day. Perhaps the feeling was mutual because the ED staff brought a cake and with members of all the departments – lab, radiology, OR and ED – we devoured it that afternoon. I was delighted and honored – the highlight of my SIM experience was working with and getting to know the people who work and visit the Granite Falls Municipal Hospital. It was confirmation of why I am pursuing a medical degree and license – to take care of people and help them with their health concerns while getting to know them and their families.

What I didn’t know about practicing medicine in a rural setting is how broad one’s knowledge base must be. Specialists only make it to these small towns every other week, or perhaps only once per month. Physicians, especially in family medicine, must be prepared for all types of complaints and all types of patients. For example, Dr. Rillo and Dr. Eakes bounce between rooms doing physicals, skin biopsies, cortisol injections, and more! The rural family medicine physician ends of simultaneously practicing in a number of disciplines including orthopedics, dermatology, ophthalmology, radiology and obstetrics and gynecology. Without consistent access to specialists these physicians develop a broad knowledge base and ability to diagnose, evaluate and treat a wide variety of conditions.

Dr. Rillo with Lily

In contrast to the controlled daily bustle of outpatient clinic, I was part of a couple more serious and emergent situations during my internship. One involved a middle-aged man with viral meningitis whose condition deteriorated rapidly. During my first week I met a subdued, kind but quiet fellow and watched him get a lumbar puncture. Not even five days later he was rushed to the ED by his wife with onset of cognitive deterioration. He was sedated and transported by helicopter to the Twin Cities. On one of my last EMT calls we arrived at a casino where an older man with a history of chronic COPD was found down in the bathroom. Despite every effort to restore his pulse, including using the LUCAS, 5 rounds of epinephrine and intubation he passed away on a warm Thursday evening in the ER. I struggled with my emotions that night but found some consolation with the EMTs; together we stared up at the starry sky outside the hospital and considered the challenge of dealing with death in healthcare.

During my SIM experience I witnessed more than just procedures, making diagnoses and prescribing medications. I saw patients cry, I saw them laugh, I saw them hold their new daughter. I saw physicians and nurses frustrated when a diagnosis was not clear and anxious when a serious case came into the ED. I made friends with patients and staff and couldn’t have felt more welcome and at home. To any student hoping to experience rural medicine and rural life in Minnesota I highly recommend applying for a SIM experience in Granite Falls.”

-Lily Wood