When I first learned about the opportunity to work on an Indian Reservation during my sixth-year pharmacy rotations, I immediately knew I wanted to apply. As students, we are lucky enough to have a few options to choose from when applying, but I knew I wanted to go to North Carolina—partly because I had peers who had told me great things about the site and partly because I was familiar with the Smoky Mountains and the beauty in that area. So, when I received my schedule and saw that I would be going to North Carolina, during the fall no less, I was ecstatic. My rotation is in Cherokee, North Carolina, and as its name implies, it is at the Cherokee Indian Hospital, which serves the Eastern Band of Cherokee Indians. But it is not a reservation. The Eastern Band owns the land; they built the hospital too, and anyone who steps foot into the facility can see that. The culture of the tribe is reflected in almost every facet. But the culture is also reflected in the care, and that is why I wanted so badly to have a rotation at this site.
Throughout my entire month, I will have the opportunity to learn and apply my time in the classroom to real situations, but I will also be able to learn about a patient population, a culture that I have limited experience with, and about how there is more to healthcare than just medicine.
Within these next few posts, I will try to convey my time and experiences in North Carolina. And as the saying goes, a picture is worth a thousand words. I’ll start off with this one of the sunrise from the top of the mountain just outside of town.
Week 1 in the Mountains
Rotations for Butler students start on Mondays, unless there is a holiday, but those are always exceptions to the rule. And, since our rotation sites change every four weeks, it is pretty much like starting a new job every month. This rotation was no different. I reported to work bright and early on Monday morning where I went through orientation for the better part of the morning. I had my picture taken, received my ID badge, and got a brief tour of the facility before being dropped off at the pharmacy to meet my preceptor and the other students on rotation (I had already met one of them since the hospital has housing for its students—my roommate was from a pharmacy school in upstate New York!).
Then I got a quick tour and information session about the pharmacy, which fills on average, 1000 prescriptions a day. The amazing thing about the Cherokee Indian Hospital is that is serves as both an in-patient and out-patient facility. Primary care doctors and pediatricians have offices in what was known as the clinic—a large building which houses 12 different medical teams and serves over 18,000 enrolled members. There is an emergency department, a lab, an eye care clinic, and a dental clinic. In addition to this, there is also a 20-bed facility which houses patients who are admitted to the hospital, a wound care clinic in conjunction with physical therapy, and a complementary and alternative medicine center. This is where I would be working for a month!
In the afternoon, I was trained on their electronic health record system, then was taken on a more in-depth tour of the hospital. It was during this tour that I started to learn more about the people I would be serving during the month—the Cherokee Indians. I was told about the importance of nature and the environment around someone during the healing process, which is why the hospital is built in a way such that every room has a window with a beautiful view of the mountains. I also learned about how the hospital was built to be the center of care for this community and how important it was that the community was reflected within the walls of the hospital. On the floor, you can see the river and its banks, an important aspect of life to the Cherokee. At one end is the spider which is said to have brought fire to the community. At the other end, a water beetle, which brought water to the community. The entrance that was built to look like a basket weaved by a local woman, known as the Rotunda. The artwork, most of which was done by local artists, which incorporates the Cherokee syllabary—the language of the tribe. It is truly beautiful!
As much as I loved taking in all the different aspects in the hospital, though, I love working with the patients too! I jumped right in on Tuesday, where I worked in one of the counseling rooms, talking with patients about their medications. This is such an important part of pharmacy, and it is one of my favorite parts really. These interactions allow me to get to know someone, to find common ground and create a relationship that promotes trust and improved care. As the week progressed, I moved into the anticoagulation clinic—where patients taking warfarin (or Coumadin) would follow-up and work with pharmacists to ensure proper management—and into the actual clinic, where pharmacists were called on to follow-up with patients on a wide range of conditions, such as high blood pressure, diabetes, and tobacco cessation. Being able to work in an environment that provides me with so many different opportunities is phenomenal, and I know it is making me a much more well-rounded student pharmacist! With one week under my belt, I am excited to get back and do more next week. Until then, we have a weekend to explore all that Cherokee, NC has to offer!
Week 2 and 3 in the Mountains
Returning to a rotation site after the first week takes on a whole new look because at this point, you have had a week to learn your way around, ask questions, and find your groove in the work place. The great thing about this rotation was the daily changing of tasks. No two days were the same for me. Some days I would counsel in the morning, then work with the teams in the clinic in the afternoon. Other days I would work in the anticoagulation clinic, better known as a Coumadin clinic. Most importantly, though, every day I had a chance to talk with patients, ask questions, and help make decisions about their care.
A huge part of the reason I love pharmacy and what I do is due to the interactions and communication with both patients and other healthcare providers. Pharmacists have an amazing opportunity to not only help the patient but to advocate for them within the healthcare team. At the Cherokee Indian Hospital, there were about 10 medical teams of caring for about 20,000 patients! So, it is understandable that communication is key to be successful. Doctors relied on pharmacists to help care for the patients beyond simply supplying medications. Clinic pharmacists worked directly with patients to help them better control their diseases, such as diabetes and high blood pressure. As a student, I had a unique opportunity to lead some of these sessions, to interview patients, determine potential gaps in care, and problem-solve to close those gaps.
In addition to my patient care responsibilities, weeks 2 and 3 of my rotation also brought me opportunities to present at the monthly P&T (pharmacy and therapeutics) meeting. P&T meetings are not exclusive to 1 hospital; if a location has a formulary—a list of approved drugs available for use in the pharmacy and hospital—it has P&T meetings. Having the opportunity to present at these meetings, as a student, is a little less common, so I was very excited to have the chance to do this while on rotation! My presentation was also a bit different since it was not a drug proposal but rather an educational review on the recommended treatments for irritable bowel syndrome. I will spare you from my nerd talk, and simply say it was an excellent way for me to learn about a disease state I was not very familiar with and to provide an informative session to the doctors on staff about the available options for their patients.
Suffice to say that the middle weeks of my rotation were busy ones. But, with each week completed, we earn a weekend to explore. Cherokee is in an amazing location—both Gatlinburg and Asheville are an hour’s drive away. The Great Smoky Mountain National Park and Blue Ridge Parkway both have entrances a few miles from the student housing. The new presence of forest fires, however, have casted a smoky haze over the town making hiking and exploring the mountains a bit more difficult. The tourism season is winding down, so town is much less crowded. However, the other students and I still found time to explore some of the shops, many filled with handmade crafts by local artists, and to watch the Chicago Cubs win the World Series (I was much more excited about this than any of the other students, but they offered support for me while I cheered at the TV). It is amazing that I am nearly done with my rotation already, but I have one week left and a few more new experiences to come. Stay tuned, and in the meantime, check out these pictures and the stories they tell within the hospital!
Week 4 in the Mountains
The last week of a rotation is always a confusing time—on one hand, you have finally become acclimated to the location and feel comfortable with all your tasks, on the other hand, you are about to leave just as you started to get settled in. My last week at the Cherokee Indian Hospital was still filled with new experiences though, and new students (you can see them all below)! But most importantly, my last week was filled with reflection and appreciation for all the experiences I had this month.
I had the chance to sit in with the pharmacy resident and the physician who operates the pain management clinic. I also had a chance to go into the in-patient side of the hospital for table rounds—a quick way for everyone on the medical team to receive updates about the patients currently being treated. It is easy to think that the primary topic of these conversations would be the medicine, but it wasn’t. Many of the topics and updates focused on the patient and his or her life, struggles taking place outside the hospital. Some touched on the forest fires, which were threatening the homes of some of the patients. Others focused on reunions of family deaths and how this time of the year, the holiday season, can be difficult.
In all these conversations, though, one thing remained the same—compassion. It can be easy to get caught up in the medicine; after all, there are so many novel treatments and interesting research trials to capture the eye. There is more to that though, and that is what my time in Cherokee taught me. Care comes in all forms—sometimes it is a hospital room with a spectacular view of the mountains, other times it is a simple question of ‘how are you doing?’
I have always wanted to do something with my life that serves others. For a while, I thought about being a teacher (I still do, but in pharmacy now!), and then I found pharmacy. It combined my love for math and chemistry with the ever-changing world of medicine. But most importantly, it provided me with an outlet to show compassion and make a difference in others’ lives, to have an impact. But truthfully, my month in Cherokee made a difference in my life and had an impact on me.
If someone would have asked me when I started my journey at Butler if I could have imagined it would take me here, my answer would have been no. I was not keen on being away from family, traveling to a place where I know no one. But, here I am now, a month later and I can’t imagine my rotation schedule without Cherokee.
If there is one thing I want to share (apart from the pictures of course), it is this—don’t be afraid to do something different, to go somewhere new. Learning happens all around us when we step outside the classroom, all you must do is talk to others and listen in return.