Wax On-Wax Off

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 “pharmacist”, 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 wrong”. 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.