The best months to set up a “Shadow” day to follow a nurse anesthetist is now – between the months of September and January.  These are the months when our first year students are busy in the classroom and the clinical staff in the operating rooms are free to turn their attention to potential candidates entering the program of nurse anesthesia.  We do allow candidates to shadow all year long but the days are more restrictive.

Recently a persistent young man was able to come by and was shown around our dearly loved County Hospital.  It was a busy day.  Maybe that is for the best because it gave a realistic picture of whats its like to have a clinical practice in a large public hospital.  My kinda place.  What follows is the beginning of a screenplay I am sure.  The names have been changed to protect the innocent but the gist of the story is all factual.

Enjoy and let me know what you think.

Red Blanket?…What’s a Red Blanket?

By Hugh Adair

I met David at the double doors of the hospital entrance on the second floor. 6:30 sharp. The introduction was brief and to the point. “We need to get you into scrubs,” he said. Scrubs…awesome. I couldn’t believe this was actually happening.  I was so excited. I came across David’s blog Nurse Anesthetist, several months ago as I was scouring the web trying to find as much information as I could about CRNA’s.  At 35, I decided the life of a television producer was no longer going to fit. For 13 years, I worked in post-production for network and cable television. As a husband and relatively new father of two (a 3 year old son and a 1 year old daughter) I realized the 15-hour day, 6-day workweek was not going to work, plus I yearned to do something rewarding. A strong desire to help others drew me to my decision to become a nurse. I had always been interested in medicine – surgery specifically. When I found out there were nurses that provided anesthesia to patients in surgery, it seemed like a perfect match. Nursing and Surgery. After reading through David’s blog about his life as a CRNA and the journey that got him there, I was even more intrigued. I wanted to speak with him and ask him questions.

One particular page that leaped out at me was an entry on the importance of a shadow day. A shadow day is when a prospective student follows a CRNA from case to case. As a shadow, you are observing right alongside the anesthetist as he or she is working. Having an opportunity to shadow a CRNA for the day would be a good test to see if this was something I was truly interested in pursuing. I reached out. I sent David an email explaining who I was and that I was interested in talking with him about being an anesthetist. I wanted to ask questions like, am I too old to do this? What are the career prospects and opportunities? I also asked if it would be possible to shadow him for the day. I sent the email. I never heard back. I was bummed.  I moved on. I searched the web looking for other possible shadow opportunities. I contacted local hospitals that employ CRNAs to see if they offer a shadow experience, I even asked an OB/GYN friend if she could help, she tried with no luck. Every request was a no. How was I to know if I would enjoy being a CRNA if I couldn’t get a chance to see what it was like? What if I were to invest all of my time, effort and tuition (not to mention the personal toll on my family) to go through nursing school, work for two to three years in ICU and then go back to school for 2 ½ additional years to finally become a CRNA – only to find out it was not for me? I needed confirmation.

Months had passed and I had almost forgotten that I had even sent an email. Then I got the word. David emailed me that his blog had been attacked by a virus and that he was sorry it took him so long to respond. He told me to call him anytime. I was ecstatic. I phoned immediately and left a message. After several rounds of phone tag over a couple of weeks (I didn’t want to hound the guy), we were able to connect. After our conversation that was kind of like a phone interview (I was quite nervous), David spoke the words that sounded like music to my ears. “Well, you need to come down and have a shadow day.” Really? Was this really what I was hearing? “How is your schedule?” he asked. The conversation ended and I met him two days later.

After a brief introduction to the incoming fall class of SRNAs and other faculty members, I was given a set of scrubs and we were off and running.

David was covering one of the operating rooms reserved for the E.R. Since these rooms are used specifically for the E.R., there were no scheduled procedures on the board.  By 7:00 am we were sent in to relieve two Resident Anesthesiologists who had been in surgery since 10:00 pm the night before. An 18-year-old male with multiple gunshot wounds to the pelvic region. When David took over, the Orthopedic team was finishing up their work and the OR staff were preparing for the Vascular team to begin their work of repairing this kid’s veins. After the exiting residents briefed David, he signed on and took over the case. David immediately begins assessing the patient, monitors and medications. David works at a rapid, yet controlled and calculated pace. Impressive. Very impressive. The patient is stable and very lucky to be alive as he lies on the table with an incision from his sternum to his lower abdomen, an incision from his inner groin to his knee and several incisions on his hip. The operating room buzzes with adrenalin. David continually monitors and adjusts his medications. He gives me a complete play-by-play of what he is doing and the reason why he is doing it. David even throws out a couple of test questions as any good teacher would. “This is an applied science,” he says. “Anyone can regurgitate information, that’s not good enough. You need to be able to practice it.” This is life or death. No room for errors.

It’s 9:00 am. Time is flying by and I am loving every minute of this experience. David needs to be relieved from this case to take over the room next door. He briefs the Doctor taking over the case. Once finished, David grabs his MP3 player and we move next door. David plugs in his music player and begins prepping for what is coming down the pike. David’s preparation is articulate and precise. Remember, no room for fuck-ups. David checks, double checks and triple checks his medications.  Once satisfied and set-up we take a quick break for a burrito. “You eat when you can,” he says. During our brief breakfast David asks if I’m still interested in pursuing the career. “Very much,” I replied. David, under no uncertain terms, makes it very clear how hard a road it is to become a CRNA. Preparation seems to be a paramount prerequisite for anyone considering applying to the USC CRNA program. In addition to courses taken during nursing school, David recommends taking additional semesters of physics, upper division chemistry and an epidemiology course. Breakfast was brief. We head back upstairs.

A 17-year-old male came in the night before with a clean fracture to both the ulna and radius. David showed me the x-ray on the computer screen. “This could be very complicated,” said David. Hardware was probably going to be needed. The boy’s mother passes by the nursing station as they wheel the patient into the pre-op room. She is visibly shaken and scared for her son’s pending operation. Her English is broken. David speaks to her in Spanish. Her eyes fill with tears. David’s words comfort her. She tells David she will pray for God’s guiding hand over him and the operating staff. I get a little choked up myself. This is real. This is exactly why I want to do this.

I follow David into the room for the pre-operative interview. The patient seems alert and lucid. David asks him how he ended up in the ER. “Skateboarding.” he said. David runs through a battery of questions. “Have you had any kind of surgery before? Any known allergies? Was he born naturally or by caesarian?” The mother had a natural birth, but premature. This was important information. David was writing down his notes when a nurse came in and said they were sending up a RB from the 6th floor. “RB? What’s an RB?”  “Red Blanket,” said David. A Red Blanket is an emergency call for surgery. An RB is a life or death call that apparently supersedes any scheduled or lower acuity procedure. David apologizes to the fracture case and tells them he will be back later.

A 55-year old female was six days out from colorectal surgery. On rounds, a resident was examining the patient and asked her to cough. The patient coughed, her abdominal sutures break and her intestines herniate. Surgery is definitely needed.  After reviewing her chart, David preps his workspace. David works expediently, yet remains cool. The OR is prepping. He turns on his music. David has an eclectic taste in his tunes, mostly British pop. I wondered if his music choices held any significance or if it was just white noise while he worked. The patient arrives, distressed. As described, a small portion of her intestines are protruding out of her stomach. The patient’s gut is severely swollen (gas). She looks like she is nine months pregnant. David reassures her and givers her something to calm her down. The patient begins to relax. As the team transfers her to the table, the patient loses control of her bowels and makes quite a mess. A slight distraction. The nursing staff make quick work and move on. David introduces another medication and the patient quickly falls asleep. Once asleep, the patient is intubated and put on the ventilator. By the way, if I haven’t mentioned this in a while, this experience is incredible. I am mesmerized, like a kid in a candy store. But I digress. The attending surgeon arrives. He and the resident get to work. It seems the patient’s fascia was not strong enough to hold the sutures. Before long, the patient is made whole and the surgery is over. I follow David as he escorts the patient to recovery. Once in recovery, David gives the post-op nurse a run-down from the surgery and follow-up orders.  This case is finished.

David makes tracks to prepare for the 17-year old with the fracture. I follow. David stops and tells me I need to go eat. My day in the OR was over. I was bummed. I was hoping he would say, “Ok, let’s go”, but I was done. Then I realized that it must be tiring having someone looking over your shoulder for six hours.  I thanked him once again and changed out of my scrubs.

David escorted me to the door where I met him. He told me once I was actually in nursing school that I should call and do it again. He was very gracious. We shook hands and he went back inside. What an experience. Thank you David.

There you have it straight from the horses mouth.  I think Hugh should stick to writing screenplays what do you think.  Just kidding.

Just so its clear, what Hugh did not notice is the communication and team work in the anesthesia department at the Big House.  We work in a team setting with M.D. anesthesiology and CRNA’s.  This is one of the great benefits for our patients.  Without being political, two heads and four hands are often better than one.  Get it?

Before the immersion process into anesthesia practice many of us had assumptions about what the world of anesthesia care is and what it takes to be a nurse anesthetist. Its only by being in the mix can it be demonstrated.  It’s only my opinion now – every one has their place in the world where they can be their best and do good work.  Where is it for you? For me its in the operating room giving kind attentive care with anesthesia and mentoring others to do the same.  Only you will be able to know if this a field that you have enough passion and drive to sustain you in order to attain the necessary skills to excel as an anesthesia provider in today’s world.

Here are a few comments from two “Shadow Experiences”.  What will yours be?

Dear David,
My observation experience was pivotal in understanding the dynamic practice of a CRNA and increased that “fire in my belly” pursuit for this field of nursing.  The moment I met Kari Cole, I was greeted with warmth and welcomed to the new state of the art LAC + USC Medical Center facility.  I met various individuals on my observation day such as the anesthesia attending Dr. Leipzig, and CRNAs Charlotte Garcia and David Godden.  Everyone was extremely friendly and receptive to my presence in the OR department.  The CRNAs that I met enjoyed teaching and it proved to be a great learning experience for me.

Through speaking with David, I learned about the goals of anesthesia and received a mini lesson on respiratory physiology.  Thanks David for taking the time to teach and give advice to me.  I spent the morning and afternoon shadowing Charlotte Garcia CRNA and gained further insight into the CRNA profession.  She provided a holistic approach to the plan of care starting with a very thorough preoperative work up that included a review of history and physical, consents, labs, EKG, x-ray films, and assessment of the patient.  CRNAs possess exceptional knowledge and astute skills which enables them to respond to the dynamic patient changes in the operating room.  On this particular day, I saw those attributes come into play as the Charlotte demonstrated diligence with induction, intubation, and positioning of the patient.  During surgery, she manipulated various medications and fluids to maintain hemodynamic stability and to ultimately achieve the goals of anesthesia.

I learned a plethora of new and interesting concepts from Charlotte such as MAC, calculating blood loss, and reversal agents.  I also received advice about the educational rigors and expectations of the USC Program of Anesthesia.  While in the OR, Kari and Charlotte taught me about anesthesia and the elderly, an approach that is unique because geriatric patients respond to anesthesia very differently than adult patients.  I would like to thank everyone for taking the time to teach me about the CRNA profession.  My shadowing experience was extremely positive and I hope to return to this facility for another observation day in the near future.

Sincerely,
Mabel RN

Thank you Mable.  You were terrific and I am looking forward to seeing your application and encouraging you during the interview process.  Mabel demonstrated the attributes that potential candidates need to succeed.  Good luck and keep the fire burning.

Here is another letter I received and held back a couple of weeks trying to figure out what to do with it.  Should I edit it a bit….Hmmmmm.  In the end here it is – another example of work from a great candidate that idealizes so many of the great qualities of nurse anesthesia practice; attentiveness to detail, patience and sound judgment.  Lisa I am looking forward to seeing you again and I know that you will do well what ever program you choose to join.  The only reason I held back on posting your letter without editing is that it seemed a little too much about me which I do not want.  So here it is.

David,

It was a true pleasure meeting you, “The Average Man” behind the making of a terrific website for people who are interested in pursuing an advanced degree in Nurse Anesthesia (NA). A few months ago I did a web search looking for sites that could answer some of my questions regarding the NA profession, without all the boring political information, and came across yours. When I arrived at LAC + USC for my shadowing experience and Mrs. Cole said I would be with you I was ecstatic, had goose bumps and was jumping for joy on the inside. I said to her David the one that developed the nurse anesthetist website. She simply said yes.  I had the biggest smile on my face that I would like to think made the sun shine brighter that day.
I would encourage anyone who is thinking of going into an advanced degree of nursing to shadow a practitioner in their chosen field.

Personally,  I have shadowed a few times which just reinforces my desire to become a CRNA.  By far, shadowing at LAC + USC has been the most rewarding for me.  Probably because they are a strong teaching and research institution. Along with their expertise staff.

As a seasoned critical care nurse I feel confident in the excellent care I provide. I enjoy and embrace learning and increasing my knowledge base because it allows me to better serve the patients I encounter. During my shadow experiences, I must admit, I am amazed at how little I really know.  This in turn just gives me more motivation to continue my professional career growth along the nursing continuum.  Although I know that CRNA school will be painstaking rigorous, I am eagerly awaiting the challenge.  The coined term a “fire in the belly” is what I felt at the beginning of my journey.  That burning feeling has now become an engulfed fire running through my body.

David, thank you for your guidance and all the wealth of information you had shared regarding the profession, preparing for it and becoming a CRNA. You patiently and thoroughly answered all my questions. In addition, I would like to thank your colleagues for being enthusiastic, warm and welcoming when I was introduced to them. All of them (including you) gave encouraging words and advice. I value and greatly appreciate the experience I had during my visit

Sincerely,

Lisa

There you have it.  When will you call for a Shadow experience?  You have to remember that only The Shadow Knows for sure.  When you do interview for that coveted spot in an anesthesia program no matter where it is the one sure question that will be asked is if you have “Shadowed a nurse anesthetist and what did that experience teach you?”  That is a guaranteed question and one you must be prepared to answer.

The next step is yours.