Dr. Laticia Stewart’s day begins hours before she ever steps inside the doors of UTMB’s Angleton Danbury Hospital.
Mondays are usually a clinic day at the Angleton Danbury Campus for Stewart. But this particular Monday starts before sunrise in Galveston, after she responds to an early-morning call for residents to cover procedures at Hospital Galveston, the Texas Department of Criminal Justice facility on UTMB’s island campus.
“I’m what you would call an aggressive resident,” Stewart says. “I want to get as much time in the OR as I can.”
That’s one of the reasons Stewart, a second-year general surgery resident, loves her work at UTMB’s Angleton Danbury Campus so much.
The general surgery rotation at the campus was launched in summer 2017 as part of the rural health track program.
UTMB’s rural health care track exists to provide an expanded learning experience focused on needs specific to medically under-served rural communities. The practice of rural medicine requires adaptation to multiple roles, knowledge about resource utilization specific to the rural setting, and an explicit ability to integrate a public health perspective into a rural practice.
All UTMB surgical residents work for two months at the Angleton Danbury Campus during their second year, working one-on-one with faculty members doing everything from assisting in orthopedic surgeries to performing colonoscopies, says Dr. John Walker, who has been a rural surgeon for 30 years, the last two at UTMB’s Angleton Danbury Campus.
“There’s a lot of opportunity here,” Walker said. “For a lot of residents, this is the closest thing to what they’ll be doing in real life.”
After Stewart completes her two cases in Galveston, she makes the nearly hour-long drive to Brazoria County through torrential rains to work alongside Dr. Steven Agle, a general, colorectal and oncology surgeon at UTMB.
The rain eases up by the time she arrives in Angleton at 11 a.m., and she’s ready to get to work. As Stewart walks the clinic hallways, she smiles and waves at almost every person she sees. “I love how everyone knows you by name and face,” Stewart says.
Since she arrived later than usual on this clinic day, Stewart catches up on some of the cases Agle has already seen. Because there’s only one resident on duty at the Angleton Danbury Campus at a time, Stewart says she is essentially the chief resident, as she logs in to UTMB’s Epic System to check the status of Agle’s patients.
During her ADC rotation, Stewart is responsible for all surgical patients and takes a leadership role in providing patient care under the guidance of Agle. In a typical week, Agle sees 20 to 30 patients a day in the clinic and has four to five major surgical cases on Thursdays, in addition to performing four to five colonoscopies, she says.
“You really get the chance to see and do all types of procedures here,” Stewart says of her rotation at the campus. “You get to see C-sections and perform everything, including hernia repairs and gallbladder removals.
Dr. Doug Tyler, chairman of UTMB’s Department of Surgery, says a community hospital provides a different environment for doctors to care for patients and that’s a valuable resource for educating residents as well.
“It’s different to do a gallbladder surgery
in a community hospital,” Tyler says. “The depth of resources is different, you don’t have the same levels of imaging, and in a smaller hospital you don’t have the depth of on-site consultants or ancillary resources as you would at a larger facility.”
For Stewart, the ADC rotation provides the exact mix of experiences she hoped to gain during her residency as she prepares for her next role: military general surgeon. Currently, she’s a lieutenant in the U.S. Navy and was commissioned at Jennie Sealy Hospital last year. Once she finishes her residency in three years, she will spend five years in the Navy and serve at least three tours of duty.
“Who knows, I may perform surgeries in Afghanistan at some point,” Stewart says. But on this day in the Angleton Danbury surgery clinic, Stewart begins by removing a cyst from a patient’s neck and shoulder.
The cyst removal takes a little over an hour. Once done, Stewart has just enough time to grab a quick lunch of Funyuns and a plate of veggies from a pot-luck taking place down the hall. Before she can finish her lunch, her next appointment begins, this time a post-operative consultation with a patient who came into the emergency room the previous week complaining of severe abdominal pain.
The consultation begins with a hug and lots of “thank yous” from the patient, who says she was thankful Stewart was her doctor when she arrived at the emergency room.
“She talks on your level and helps you understand,” the patient says. “She told me she was going to take care of me and I believed her—and she did.”
Once the appointment wraps up, Stewart completes the required paperwork and smiles. “You have to picture your patients as if they were one of your loved ones,” she says. “I have always had that taught to me.”
And Katrina Lambrecht, UTMB’s vice president of Institutional Strategic Initiatives and administrator for the campus, says being able to put such learning into practice is a key benefit of the residency rotation at ADC.
“We have always known how valuable it is to learn in a community setting,” Lambrecht says. “Not only do residents get to see a broader variety of procedures and specialties, but they get to develop personal connections.”
In the future, UTMB wants to offer this community hospital training opportunity to more than one resident at a time, Lambrecht says. Already, the Angleton Danbury Campus has started a rotation for physician assistant students as well.
“That commitment to education is part of what made this partnership so great,” Lambrecht says. “We’re continuing the legacy of building health care here and educating and training upcoming leaders in academic surgery.”
As for Stewart, she’s hopeful of what the future will bring to her as a surgeon.
“It’s the unknown and not knowing that I’m very comfortable with,” Stewart said. “I truly feel like I’m prepared to take on whatever life throws my way.”