On the fence about whether to specialize in family medicine or obstetrics, KU School of Medicine-Wichita student Michelle Baalmann opted for the former about six months ago. Completing her rural family medicine rotation in Quinter, Kansas, with Gove County Drs. Shelly and Doug Gruenbacher reinforced that decision.

"I like the fact that they do OB, ER, inpatient and outpatient," Baalmann, who will graduate next spring, said. "They do it all. You can only do that in a rural setting."

The action continued through her last day of rotation when an elderly woman came in to the Gove County Medical Center with a bleeding head wound caused by a fall. The clinic's nurse practitioner, Glenda Wheeler, asked Baalmann if she wanted to staple the wound shut, and Baalmann immediately said yes. After it was learned that the patient had fallen before and was on a blood thinner, Wheeler ordered a CT scan, which Baalmann examined on a computer a short time later.  

Her conclusion, seconded by Wheeler, was that the trauma all appeared to be on the surface of the patient's head, where a bruise had formed. The two numbed the area and began rinsing it with a pinkish sterilizing solution while also applying pressure to stop the bleeding and trying to cut away some hair to better see the wound. "You might have some pretty colored hair for a while," Baalmann joked with the patient, who remained conscious and in good spirits. Baalmann and Wheeler then realized that an artery had been hit and was bleeding.  

Dr. Shelly Gruenbacher arrived, scrubbed in and started trying to ligate the artery, but had trouble locating it, partly due to continued bleeding. "That's why you wear a mask in surgery," she said after being squirted at one point. About the time Dr. Doug Gruenbacher came in, Shelly Gruenbacher succeeded in tying off the artery.

It was one last reminder that "you have to be ready" for complications, Baalmann said. "That's something you don't see every day."  

Baalmann usually saw about 15 to 18 patients a day during the four-week rotation, starting with 8 a.m. pre-rounds in the hospital and continuing with outpatient care at the attached clinic until about 5:30 p.m. Living in a house across the street from the hospital, she was also on call three nights a week. "Even on days you're not on call, if you have an OB (patient) who goes into labor, you go in for that," she said.  

Baalmann assisted in four childbirths. "You catch the baby if it's not complicated and help to sew it up if they have a tear," she said.  

She said seeing babies who she'd helped deliver come in for the first well-child checkup "is a pretty special feeling. You feel like you're a part of their life. I like seeing how they're out of the hospital at the beginning of their life and that they're growing already."  

She saw a number of patients with diabetes, often with multiple other medical issues as well. She noted that the Gruenbachers employ a range of remedies -- medication, diet, exercise -- with care plans individualized to each patient.  

"The management of each patient brings up something new every time."  

Although both Gruenbachers practice the full range of family medicine practice, Shelly handles more prenatal and pediatrics cases while her husband sees more adult patients.  

Baalmann helped to treat an elderly woman with a serious urinary tract infection, which caused her to become septic. She was stabilized and transferred to the intensive care unit in Hays, about an hour down Interstate 70.  

Among other cases, Baalmann removed a couple of patients' moles, treated a young woman who'd developed a skin infection after being bumped off a horse, and examined an elderly man suffering from depression and intestinal trouble in addition to diabetes. On the second-to-last day of her rotation, she performed three colonoscopies.  

"You get a lot of hands-on experience," she said. "It's really involved."  

Baalmann said the rural rotation gave her more confidence in her clinical skills and ability to manage patient care, and Shelly Gruenbacher wholeheartedly agreed. Both Gruenbachers are graduates of KU School of Medicine-Wichita and its Smoky Hill Family Medicine residency program.  

"We push students to be as involved as they want to be," Shelly Gruenbacher said. "That allows their confidence to really blossom. She (Baalmann) is one I've seen get more confidence and be part of the patient care team."  

Said Baalman: "They are their patients but (the Gruenbachers) make you feel like you're part of the team."  

The Gruenbachers typically host about a dozen KU students a year, which means their patients are used to being taken care of by students. Baalmann said she went to Quinter's homecoming parade and "everybody was very welcoming." That includes a woman who nearly ran her over in a car. As it turns out, the lady mistook Baalman for a friend's daughter and playfully swerved toward her. After realizing her mistake, she brought an ice cream cake to the clinic the next day.

Baalmann grew up in Colwich, majored in biochemistry at the University of Dallas and then earned her master's degree in pharmacology at Tulane University. Her older brother, Damien, is a doctor at Barnes Jewish Hospital in St. Louis and her older sister, Jennifer, is a family medicine resident at Wesley Medical Center in Wichita. Joseph Baalmann, a first cousin, is a family medicine resident at Via Christi.  

Her parents are dairy farmers, which Baalmann said gave her a connection to many of the rural patients she saw here. After graduation, a family medicine residency is the next step for Michelle. From there, Baalmann said she couldn't predict whether she'd practice somewhere like Quinter.  

"I don't know where. Wherever I'm needed."