Derry students get bedside view of healthcare
By Jeff Himler
Published: Friday, April 15, 2005
DERRY--Fictional television shows such as ER can give young viewers like Kelly Nicely the feeling that they've peeked behind the scenes at a trauma center.
But, unlike most high school students, Nicely and a few of her classmates have spent time in an actual hospital emergency room and operating room, watching doctors practicing medicine on the front lines.
Nicely is one of nine Derry Area High School teens who have observed a variety of procedures at medical facilities this school year, through the semester-long Allied Health Professional internship program.
Based at the Eastern Westmoreland Career and Technology Center since 1996, it is offered to a maximum of 18 students at a time from the ranks of juniors and seniors at the Derry Township school.
While witnessing removal of a diseased thyroid at Excela Health Latrobe Area Hospital (LAH), Nicely noted conditions were far less frenzied than in the operations conjured up by TV writers.
"Everyone wasn't running around like they do on TV," she said. "I really enjoyed the atmosphere (in the operating room.)...I was impressed that I didn't get sick."
A good thing, since Nicely hopes to become a nurse anesthetist--following in the footsteps of longtime family friend Leslie Mc-Clarren, whom she will be shadow for eight hours in May at LAH in the final "prac-ticum" phase of the Allied Health course.
Nicely, who will attend the University of Pittsburgh, noted her career choice was influenced both by McClarren and by her mother, who has worked in nursing.
According to instructor Lindsey Smetak, a registered nurse and a 1987 graduate of Laurel Valley High School, Nicely had to make the grade, academically and in terms of attitude, to earn a spot in the course.
Due to growing demand, "I've had to increase the enrollment. I used to keep it to between 12 and 14." And still, filling those slots is "a highly selective process."
She said she takes only top students. "I look at attendance and grades," with math and science ability particularly important for success in the world of medicine.
Though about half have not yet decided on a preferred specialty, Smetak said her students "all have a desire for entering health care. These kids are pretty focused. They've done a lot of research, and some of them come in here very knowledgeable."
A dozen students already have signed up for next year. "Those are just the ones I've selected," she pointed out. Others were turned down because of academics.
The Allied Health course lets the students sample various medical fields and occupations, while they explore tasks and work environments which they'll face on a daily basis if they go through with career plans.
For most students, the course confirms what they already know they want. But for others, it totally changes their decision.
Smetak recalled a student who expressed an interest in training as a physical therapist, then discovered "she didn't like dealing with older people." She had to be gently informed that physical therapists spend the vast majority of their time working with older adults, not pro football players. or even physically challenged children, she said: "Not many people are able to slide into a position like that."
Working with the elderly isn't a problem for Derry senior Jennifer Brant, who is planning to complete a practicum in occupational therapy before she begins training at the University of Pittsburgh at Greensburg.
Brant credits a relative for inspiring her career choice. She noted a cousin, 16, was affected by spina bifida. Without the assistance of therapists, she asserts, her cousin "wouldn't be able to feed herself."
Brant already has gained an insight into nursing, having worked for nine months as an aide at Loyalhanna Care Center near Latrobe. "I love to help people," she said.
In that job, "The best part is when you're making a resident smile. A lot of them don't have family to visit them." On the other hand, "The worst part is when you get close to someone and they pass away."
She experienced that situation with a woman in her 80s who "just went downhill. I cry, but then I think that she's not suffering anymore and I'm happy."
If they are serious about a medical career, Smetak said, students must learn how to serve their patients' changing needs throughout illness, including a terminal one.
She noted some teens mistakenly think, "People who are dying don't have a life. There are different stages of an illness and you have to deal with each of them."
"I move the programs around a lot, from year to year," based on students' interests," Smetak said.
Agreements are in place for students to observe professionals at work at Excela Health, Mountain View Specialty Care and various private practices in the area.
That includes Dr. Derek Peske of Greensburg, whom Smetak describes as "an old-time doctor who spends half an hour with each of his patients...A lot of students choose to go back to him because he's such a great mentor."
Those interested in becoming a veterinarian may visit an animal hospital near Latrobe.
The initial six weeks of the Allied Health program focus on classroom instruction, covering issues of importance to anyone going into the medical field.
Said Smetak, "We talk about medical technology and ethics," including federal law that protects the privacy of patients' medical information.
"We talk a lot about liability and malpractice insurance," she added. "That's something they need to consider."
And, Smetak said, "We have tons of speakers," including Westmoreland County Coroner Ken Bacha, and personnel from Pittsburgh's Allegheny General Hospital, who speak about trauma care.
She said the students also learn about the body's basic systems, to give them a better understanding of some of the medical procedures and terms they will encounter.
According to Smetak, the heart of the course is the experience the students gain when they visit various medical facilities. "The main focus is on the practical," she said.
About seven weeks is spent in "clinical rotation," as the students gradually visit various types of medical practices and hospital departments. Those may include respiratory therapy, nuclear medicine and pediatrics.
Students must show maturity and responsibility, as they provide their own transportation to many clinical outings.
During the rotations, the LAH operating room is a popular destination. "The kids love the OR," Smetak noted. "They are right there at the bedside."
Another annual highlight is observing an open heart surgery at AGH in Pittsburgh. The students were to have witnessed such a procedure this week.
Smetak and the students were to be at AGH at 8 a.m.
"We go upstairs to the observatory, where we can look down on the patient," she said. The students "see the harvesting of the vein" from a limb to bypass a blockage.
Also, "They see all the members of the OR team. Not everybody is touching the patient."
At AGH, the surgeon wears a microphone, making it easier for the students to follow the operation. "At times, he will take questions," Smetak said. But the surgery they observed last school year was a little more tense: "He didn't talk as much. It was an emergency--a 36-year-old woman who had a heart attack."
Witnessing surgery without squeamishness is one litmus test the students apply as they weigh career choices.
Smetak recalled, "One girl would pass out every time she saw blood. But, when we were in the operating room, she had no problem."
She noted, "A couple of students had to come out of the operating room to sit down." But the restrictive garb students must wear, to help keep the room sterile, may have contributed to their distress.
"You have to have a mask on in the OR, so you're breathing in your own carbon dioxide."
"We had to wear bunny suits," Derry senior Amber Okert said, describing the sterilized outfits. As a result, "It was a lot hotter than you would imagine" in the OR.
But a jump in temperature wasn't the only heat Okert noted. "The stressful situation is the only thing stopping me from wanting to be a surgeon," she said.
Still, she is planning to return to the operating room for one of her practicum experiences.
Smetak has been a nurse for 15 years, supplementing her job at the technology center by filling in at a Latrobe doctor's office.
In her career, she's had to get over her own distaste for mucous.
Before making clinical visits, she said, "I talk with the students about what they'll see. When they see people on ventilators, they're going to see a lot of mucous."
Driven by the CSI franchise on TV, pathology is another area of interest for some students.
While the students may see lab workers examining specimens from the deceased, she noted they're too young to view corpses.
Unlike on CSI, the youngsters learn, "Cases in pathology can't be solved in an hour."
Alexis Smith, a Derry senior who took the Allied Health course last semester, is planning to study forensic science and the law.
Smith said she became intrigued with the field when physical evidence became a major factor in both the O.J. Simpson trial and in the unsolved death of JonBenet Ramsey.
"I want to be a medical examiner, like Cyril Wecht," she said, referring to the Allegheny County coroner and frequent medical expert in high-profile legal cases. "I want to have a career that isn't the same every day."
She was further convinced after reading a book about a medical examiner.
Though she was unable to find a practicum mentor in her field, Smith said the Allied Health course helped clear one nagging concern: "I didn't know if I'd be able to handle seeing everything," including body parts and fluids.
But, after observing an appendectomy, she learned, "I can look at blood."
As to other bodily fluids, she recalled, "A lady was throwing up in front of me in the emergency room. It was kind of gross, but I was fine.
"The doctor asked, 'If I give you a big doughnut, would you be able to eat it?' "
Smith completed two practicums--with Dr. Larry Kachik, director of emergency medicine at Excela Health--LAH, and with Peske. She was pleased to note that, unlike some of the jaded physicians portrayed on television, Peske "knew everything about all his patients."
"There are a lot of eye-opening things," Smetak said of the course's on-site experiences.
In some cases, she said, students find a medical specialty holds their interest more than they would have expected.
When students observe speech therapists at work, she said, "There are a lot of surprises. They don't realize that a lot of the work involves helping people to swallow," not just teaching them to pronounce words properly.
Last Friday, the students visited the radiology department at Excela Health--LAH, where they observed two diagnostic technologists, Luanne Plyler of Ligonier and Toni Ellenberger of Derry, at work.
They asked questions as the pair processed x-ray images of a female patient's skull. The interior view will help doctors determine how much she is benefiting from an implanted "programmable shunt," meant to drain fluid and relieve pressure on the brain.
Ellenberger also explained the use of an intravenous pyelogram, which directs a dye through the kidneys to check for kidney stones or other problems.
Usually, she noted, "The dye ends up in the kidneys within two minutes."
But, before the procedure is carried out, testing must be done to make sure the patient won't react badly to the dye and that his kidneys are healthy enough to withstand the procedure.
"The test makes the kidneys do extra work," Ellenberger explained.
The students also wanted to know whether radiology is a promising field.
When she entered it in 1992, Ellenberger told the students, "The job market was flooded." But, "Right now the outlook is pretty good. People who have been graduating in the last couple of years have been finding full-time jobs right away."
Phyllis Ruffner, manager of educational services for Excela Health--LAH, indicated the primary benefit of the Allied Health program has been "exposing students to the opportunities for careers in health care.
"There's such an issue with young people graduating from college and thinking they don't have job opportunities. We're working hard to encourage them to come back to this area; there are jobs for them here in their own backyard."
In addition to radiology, she cited nursing and pharmacy as areas where jobs can be had: "There's a real market need for those positions."
According to Smetak, "There's a big demand in nursing, but, "The salary is not that good. Physicians still are the highest-paid."
But, she noted, a doctor in training must devote eight years to schooling, while spending at least two or three more in residency, depending upon the person's specialty.
Smetak agreed that the pharmacy field can be a good choice for those considering options in the medical field.
Though six years of schooling is required, she noted those who successfully complete their studies can expect annual paychecks of $80,000 or more.
"There are no unemployed pharmacists," she added.
Several of Smetak's students have expressed interest in the pharmacy profession, including Derry senior Chelsey Harshell, who has selected it as her major when she enters the University of Pittsburgh at Johnstown.
He choice was motivated by an experience in her family, she said.
She explained her grandmother received a doctor's prescription that conflicted with medication she already was taking: "The pharmacist didn't catch it; she could've really been hurt."
Harshell is determined to be vigilant for such problems once she is in charge of dispensing medication.
Overall, Smetak said, most medical fields are expected to be expanding by 2010, due to continuing advances in technology and aging baby boomers in need of more and more medical services.
But, she noted, training requirements for some fields also are increasing, with a movement toward a six-year degree program for occupational therapy.
As part of the students' grade for the Allied Health course, Smetak said, "At the end, they do a research paper related to each of their practicums."
She tests them every nine weeks on medical terminology.
Also, "They make journal entries for every clinical rotation they complete," noting the function and duties of the medical staff they observe and offering their own opinion of what type of person works best in that job."
Conversely, the students are evaluated by their practicum mentors and also are asked to evaluate themselves.
Smetak explained the students must decide whether they have the "right stuff," personality-wise, for the medical field they are considering.
"They're asked to explain why they do or don't like a particular job," Smetak said.
"If you don't like to touch people, maybe you'd be better off in the pharmacy field."
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