Archive for March, 2005
Power Outage at LAC-USC and New Student Interviews
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Generators are a good thing especially in hospitals. This last week the eastern edge of Los Angeles experienced a power outage that lasted for a couple of hours and shut down the operating rooms at LAC-USC hospital. Well, shut down is not the exact word for it really; we were interrupted by the power outage.
It was a beautiful sunny morning in Los Angeles; the birds were singing and the hillsides never greener after all of the rain that we have received in the past several months. Surgery had been planned this morning for a young girl with a pelvic fracture that occurred during a motor vehicle accident a week ago. I had just induced general anesthesia and intubated this 17 year old girl when the lights in the operating room went out. She had been sitting in the back seat of a parked car several days before when a bus slammed into the side of the sitting car injuring all of the passengers. This sweet high school student and her family had been waiting for her pelvic fracture surgery for a couple of days now. She had an unstable pelvis and today the orthopedic surgical team was planning to stabilize her SI joint (sacroiliac) with pins. We were just about to turn her to the prone position when the lights went out. Read More→
Wax On-Wax Off
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Gina Wald, DC BSN CCRN
Gina comes to nurse anesthesia practice prepared as a doctor of chiropractics. Her experience includes several years as an RN in a neuro/trauma ICU. Her insightful assessments and understanding of anatomy is enormous. Here are a few of her insights at the start of clinical anesthesia rotations.
My favorite preceptor is not the warm fuzzy type. She is a compact, Korean woman with over 20 years’ experience in anesthesia, moves with great efficiency, and dresses for function in the OR, a terrycloth sweatband under her paper cap and too-long scrub pants tucked into her paper booties. On my first day with SJ, she told me she would not hand me an anesthesia mask until I could properly open a patient’s mouth, and wouldn’t dream of handing me a (laryngoscope) blade until I could demonstrate profiency at masking a patient. She was not exaggerating. SJ would never exaggerate.
My first experiences with SJ were utterly exhausting. My first tasks were to prepare the patient for anesthesia. Position, monitor, oxygenate. Sounds simple I know, but with SJ there is always so much more than is at first apparent. Eventually, she played “pharmacistâ€, pushing my drugs while I fumbled with everything else. And oh how I fumbled. You see, SJ did not care that I was left-handed, insisting I learn how to do everything from Day One with my right hand. “You already have the advantage of a lifetime spent accomodating. Learn with your right hand now, and everything will be easy with your left.†My husband and I came to call her Miagi (the teacher in Karate Kid), and her wax-on wax-off philosophy of apprenticeship has been transformational for me. I now insert arterial lines, IVs, spinal blocks, and any other device thrown at me right-handed.
After I completed a successful (right-handed) spinal (subarachnoid block) and settled my patient for his procedure, SJ brought me to a quiet corner to tell me I had “done everything wrongâ€. Through the rest of the case I practiced my needle technique, and for my effort received a curt nod of approval on the next successful spinal. During cases, SJ drills me on hemodynamics, drug pharmacology and interactions, pulmonary function, complications, pathology. “What would you do if the patient started moving right now?†Satisfied with my answer, SJ jots down her pager number and leaves the room, the ultimate compliment.
When I voice my frustration over my incompetence, SJ tells me, “I do not worry about you. You have a brain. I cannot teach you to have a brain. Everything else, a monkey can learn. It will come.†SJ has burned a place in my heart with the other great teachers I have had in my life, and her lessons will stay with me forever. Every time I give a pressor, I tell myself BP= SVRxCO; CO= SVxHR. Which component is the problem with my patient, and which am I about to effect with this drug? SJ has taught a generation of successful anesthetists to use their brains and train their hands. I am now part of her legacy, and honored to have such a teacher. Wax on. Wax off.
James Answers Gina
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James Ukena is a nursing student at the Central Queensland University, Australia. He is nearing graduation and will be moving to the New York/New Jersey area and plans on working at the University of Columbia network hospitals in preparation for Nurse Anesthesia School there. He has started a weblog for students at the Central University of Queensland where his latest goings on can be found.
Hi Gina,
In reply to your question “I am curious as to how you came to the decision to pursue Nurse Anesthesia, given that your country apparently does not utilize them? †I must say I had to think about that question carefully. I think the pathway to get me interested in NA was after my first year undergraduate results were revealed. I was blessed with exceptional grades, in fact I am currently holding the highest GPA for my year level at my University. The Head of nursing sent me a letter to pat me on the back and suggest I start considering postgraduate studies (I think you call it just graduate study over in the states).
My research took me to many different areas of interest. Then my wife reminded me that the program I choose must be available in the States. Why? Because we intend to immigrate to New Jersey/NewYork to be closer to my wife’s family who live in the Jersey suburbs. So I began examining the U.S options for graduate study in Nursing. I knew NA was for me and not neccessarily because of the money, although it is a nice reward.
My main reasons was the autonomy; the increased chance of daytime shifts (I prefer daytime shifts and most weekends with family……if possible); and an opportunity to exercise the brain muscles a little. An old high school buddy who is now an anesthesiologist and has trained at Mt Sinai in New York has also given me encouragement to follow this career path. The MSN in anesthesia is for me! The opportunity to continue in human services but also challenge my own abilities, pushing the envelope.
David’s site was an accidental suprise. I stumbled across his site as he was beginning describing the life of a NA student. Already I feel less apprehensive having read all of your posts.
I continue to read your posts regularly with interest.
James Ukena
Central Queensland University
Queensland Australia
The Kindest First Year Rotations
Posted by: | CommentsGina Wald, DC BSN CCRN
Gina comes to nurse anesthesia practice prepared as a doctor of chiropractics. Her experience includes several years as an RN in a neuro/trauma ICU. Her insightful assessments and understanding of anatomy is enormous. Here are a few of her insights at the start of clinical anesthesia rotations.
Though I am not the blogging sort, I am supportive of this forum; I would have loved a resource such as this when I was investigating and applying to NA school. The webmaster has graciously invited me to “join the conversationâ€, so here I am…
We started our first rotation a month ago, after a meager but grueling semesters’ preparation. I will never forget the tension in our classroom the week before we were to be cast to the lions.
Even the loudmouths of the class (myself included) were scared into silence. We knew what to expect, and while all 16 of us started this journey anticipating, even desiring a life-altering residency experience, we were scared. It was a strange mix of “I can’t wait to get started” and “Wait, I’m not ready yet”.
I am in the “kindest” of first year rotations, a So. California Veteran’s Administration Hospital where the CRNAs and attendings are brilliant, eager to teach, and supportive of our endeavors. And still I am exhausted. I cannot find time to do it all. I feel strapped beyond belief. I want to read more, to know and contextualize more, to have time to reflect on all that I am learning and doing. But there is no time. I determined last week that I must stop working, as much as I love having a place to go where I actually have some competence. It’s time to leave the nest, and begin the plummet we all must take before feeling our wings.
Days in the OR are wonderful. We start morning conference at 7:00 am with the CRNAs and Attending anesthesiologists. We present our cases for the day, and take whatever beating is dealt out. They kindly remind us that while we have looked everything up in the books, we still don’t know much about anesthesia. It’s important not to take it personally, and I worry about those of us with too thin skin. (Dermal hypertrophy should be listed as a prerequisite for all NA programs). There is no coddling here, but I know they are grooming us. We have only 18 months to go from inept to competent. I love the regional anesthesia exposure we are getting at the VA. As a chiropractor, I know my hands are good, I know the anatomy intimately and can visualize the structures as I place my needle. This is fun for me. Intubation is another story, and while my first couple seemed easy enough, I have struggled since then, taking in everyone’s advice, trying to keep my frustration from invading my thoughts during induction. There is always something I forget to do in a case, and I wonder how long it will take me to “get it”.
I love what we are doing. I love watching the transformation take place in my classmates, and feel my own mind making a very clunky shift. The skills and knowledge I brought from my experience as a neurotrauma nurse serve me well, but the thought process in anesthesia is a different paradigm, one which is much more in line with my background. This is such an exciting time, and everything I was looking for. If only I could get some sleep. To be continued….
