Kelli Paice’s elective with Josh Pacheco, UMass Chan RHS grad, in Hamilton, Montana (Summer, 2015)

During the month of September, I had the amazing opportunity to travel to Hamilton, Montana to work at Marcus Daly Memorial Hospital – a critical access hospital in the Bitterroot Valley. I worked in the ER with Dr. Josh Pacheco, a UMass graduate who is now working as an emergency physician in Hamilton.

For a critical access hospital, the Marcus Daly Memorial Hospital Emergency Department does quite a lot of business. While some of the chief complaints were similar to those I might see in a New England city like Worcester (chest pain, vertigo, kidney stones, etc), some cases were pretty uniquely Montana. One day we treated a number of parachute-related injuries from military training going on in the mountains surrounding the hospital. Horse accidents were commonplace, and so were lacerations – helping repair the tendon of a teenager who had cut his thumb while slaughtering chickens was particularly memorable! I also saw numerous patients with asthma or COPD exacerbations related to smoke from the wildfires that plagued the northwest this summer. 

                               
                   A comparison of what the hospital looked like in the height of the smoke, and after it passed.

Outside of the ED, I also had the opportunity to spend a few days on the inpatient medicine service at Marcus Daly. The entire hospital contained 25 beds and at any given time, was covered by one hospitalist and a close-knit bunch of nurses, therapists and care coordinators. I learned that the critical access hospital even doubled as a short-term nursing facility at times, because of limited access to rehabilitation centers in the area.
The major difference I noted between working in a rural, critical access hospital and an urban, academic tertiary care center was access to resources. The providers in Hamilton are often on their own when it comes to making decisions – consultations for many specialties are simply not an option. 

There were some days when there was not even a single surgeon on call, and even if there was a surgeon available, a case might still be sent out to another hospital miles away if the patient required platelets - one of many resources Marcus Daly does not have the patient volume to maintain. Blood supply is extremely limited, which makes obstetric emergencies particularly nerve-wracking for the OBGYNs. When the ED gets a call from EMS about a chest pain case, the doctors must make a split-second decision about whether they will be able to care for the patient, or if they should redirect the ambulance to the closest cath lab, 45 minutes away in Missoula! More specialized care required transfer to Spokane, Washington, 4 hours away.

Western Montana is probably one of the most beautiful places I have ever been. During my month in Montana, I was able to explore the not-too-distant Glacier, Yellowstone, and Grand Teton National Parks. I also was lucky enough to be in town for the Ravalli County Fair and Rodeo. There’s nothing quite like watching people throw themselves off of horses while trying wrangle escaping calves to remind you that you are no longer in Massachusetts!

                          

                                                                
                                             Photos from Yellowstone, Grand Teton, and the rodeo!     

Overall, I had an incredible experience working in Hamilton, and cannot thank Dr. Pacheco, the staff of Marcus Daly Memorial Hospital, MassAHEC and the UMass Rural Health Program enough for helping to get me out to Montana!