Thanks to Laura and Carie for finding and forwarding some cool anesthesia-related online content!  Laura sent me the link to the BIS website (here) where you'll find some automated anesthetic simulations.  And Carie told me about a site called "Airway World" (here), which is pretty much where I feel I've been stranded and left to die for the past 18 months.  Just sayin'.

Happy surfing!

As a military brat I've learned that it takes a full year to feel at home in a new place.  It literally takes 12 months to make friends, learn the names of streets, find shortcuts to your favorite restaurants, and get settled into a routine.  I found the same to be true for nurse anesthesia school.  While being a student nurse anesthetist is, in itself, an exercise in stepping outside of one's comfort zone, I finally began to feel comfortable with my surroundings and the expectations that are placed upon me in the OR once I wrapped up my first year of schooling.

Big mistake.  Big.  Huge!

I recently had a tough rotation where I felt like I couldn't do anything correctly.  I returned home every night feeling stressed out, disappointed in my performance, and tired as hell.  It took one particularly rough day near the end of the rotation to realize a very important lesson that I'd failed to embrace until now: The clinical expectations of a junior student are far different than those of a senior student.  As a junior, you aren't expected to know very much at all about administering anesthetics.  Because of this you're coached to deliver anesthesia in accordance with the preferences of your particular CRNA and encouraged to ask questions and garner your CRNA's approval before taking any action in the OR.  As a junior, it behooved me to run my anesthetic plan by my CRNA, making any changes he or she desired before taking action.  As a senior student, however, CRNAs are much more willing to trust your skills and planning and many of them expect you to deliver anesthesia as if they are not even there.  I love it when my CRNAs take this approach, given that I will be delivering anesthesia without their help in just 8 or 9 months.  However, I'm so accustomed to discussing my my plans by my CRNA (especially since some CRNAs still want and expect this courtesy!) and I've realized that, by doing this, it seems as though I'm unprepared or lack the knowledge needed to make independent care decisions.  I'm working now to make the mental shift necessary to succeed as a senior but it hasn't been easy.  

It's kinda like moving to a different town called "Seniorville".  And while I'm happy to be here, it's been a challenging adjustment.  But if Shaq can lead the Boston Pops Orchestra, I sure as heck should be able to make a minor adjustment to my clinical routine, right?!

My digital watch kicked the can last month and I've yet to replace it.  I decided that, rather than purchasing a ho-hum Timex from Target again, I'm going to invest in a timepiece with some character.  After all, a watch is about the only style statement one can make when decked out in scrubs in the operating room!  Below are a few of the watches I'm considering:

I arrived at the hospital this morning expecting to begin another regular day of clinical.  Instead I found the following gift waiting for me in the anesthesia workroom courtesy of Lacey, one of the unbelievably thoughtful and amazing CRNAs employed at Wesley Long Hospital.

For every CRNA who intimidates me, there's another CRNA who blows my mind with his or her kindness and capacity to mentor and educate future practitioners.  Thank you Lacey, for being one of those people.

I've been in the regional anesthesia clinic for the last 5 weeks.  That means it's been 5 weeks since I last induced a single patient, 5 weeks away from a gas machine, and 5 weeks since I've laid my hands on a stick of propofol.  But all that's about to change because I'm back in the game starting tomorrow!  That's right, my return to the OR commences in just a few short hours and I couldn't be more excited.  And nervous.  Heck, you would be nervous to intubate a patient too if you hadn't picked up a laryngoscope in 5 weeks!

Which is why I plan on putting my own spin on this little girl's pep talk while looking in the mirror tomorrow morning:

Hey, it couldn't hurt.

LYLAS!

Amy

If I were a celebrity, and I think we can all agree that I totally should be, I would no doubt be a top contender for VH1's Best Week Ever.  Though if I were featured, the program's title would have to change to Best Week EVAR because that's how great my week was.

They* say that one day, after months and months of frustration in the OR, you'll just "get it".  Everything finally falls into place and many of the tasks students struggle with and the skills requiring conscious effort suddenly become second nature.  Well, it freaking happened.  Not only did I work with great CRNAS and surgeons all week, but I finally got it.  I remembered to turn on my gas, intubated patients with ease, and my wake-up times were perfectly timed with the procedure end times.  I was more on top of things than... ummmm... (insert Tiger Woods joke here).

It was one of those weeks that makes you want to throw your coat over the chair, gaze longingly out the window, and pull a Hugh Grant from the film Love, Actually.

* I don't really know who "they" are, but I do know that "they" are almost always right and if you ever have the opportunity to fetch "they" a cup of coffee or gasp at the beauty of their children without coming across as a complete brown noser, you should probably take it.

 
With the start of clinical, every anesthesia student must face their biggest fear: getting "pimped".  But it doesn't mean what you think it means.  No, pimping in the world of health care is an entirely different beast altogether... Though it too should be illegal.


While I've definitely been verbally tested in the O.R., the questions I've fielded thus far have all related to the topic or patient at hand and were better categorized as teaching tools than straight pimping.  But that all changed this past week.  That's right, guys, I got pimped so hard I was leaving the hospital staying things like "well color me happy, there's a sofa in here for two!" and "big mistake... Big! HUGE!"

Some of the questions?  "Why would a patient's expired oxygen register a few percentage points lower than their inspired O2?" and "Say you have a patient who is undergoing a laparoscopic cholecystectomy.  You notice that their ETCO2 is increasing, but none of the other monitored values have changed.  Increasing the patient's minute volume has no effect in decreasing the CO2.  What is the cause of this issue and should you be concerned?"

I wish I could provide you with the answers but frankly I'm quite busy at the moment, curled up in the fetal position, sucking my thumb and repeatedly asking for my mother.

My day in the OR - complete with multiple failed intubation and LMA placement attempts - has left me pretty discouraged.  I felt like my two shifts in the Outpatient OR last week were productive and I arrived home from each with a great natural high going on.  (Or maybe I should have re-checked the gas scavenging system on my anesthesia machine?)  But today was just the opposite.  Hence the song.  "Two steps forward, two steps back"... get it?  Even if you don't appreciate my reason for including the above video as my song of the day, you really should thank me for reintroducing you to one of the greatest music videos of all time.  Right behind "Thriller" and Aerosmith's "Crazy", in case you were wondering.


P.S. If I didn't believe my program administrators before when they told us that anesthesia school was a roller-coaster, I sure as heck do now.

Though, I gotta be honest, it wasn't pretty.  Let me put it to you this way: If the following video is what a flawless intubation by a seasoned CRNA looks like...



Then this is how mine went down...


...In other words, it went exactly as you'd expect a first intubation to go.  But, while I didn't get any "style points", I got the job done.

Go me!

* It was a toss-up between the SNL clip and this video.  Given that I'm using this as a metaphor for my intubation technique, I think it goes without saying that I would be the girl on the left who's sporting a massive wedgie.

After two arduous months of classroom studies, my fellow SRNAs and I are headed to the operating room for our first official hands-on day!  I can't even begin to describe how excited I am to have made it through these first 8 weeks.  It's almost as if I've been in the midst of preseason training, cranking out two-a-day practices (the kind where your coach forces you to do sprints until the entire team's stomach contents are splayed across the sidelines) for weeks on end.  Don't get me wrong, challenging and tiring practices are integral to the success of any athlete... I'm just ready to get in a game.

My season begins tomorrow morning in the GI Lab.  Kick off time is 4:30 am.*  GO TEAM!

*Never in my life have I been this excited to wake up at the crack of dawn... anesthesia school does very, very strange things to a person.

My good friend, Mark, is currently attending the University of Washington's physical therapy program.  I had the opportunity to visit him this past March and, in typical fashion, hilarity ensued.  One of the more memorable events stemmed from my convincing Mark to bequeath me his cherished Cardinals tee-shirt.  (We both attended high school near the city of Saint Louis.)  It is one of those soft and well-worn articles of clothing that has been perfected via 10 years of use.  Make no mistake about it, people, I wanted this tee-shirt... which is why I was fully prepared to offer my dignity in exchange for the thing.

Mark, in a moment of weakness, agreed to relinquish his beloved tee under two conditions.  The first being that I wear the shirt, positioned like a sash worn by beauty pageant contestants (how fitting!), as we bar-hopped throughout the city of Seattle over the course of the night. 

Mark's second demand was that I include "The Sash", as it came to be called, in major life events.  You know, like take it sightseeing.  Invite it to my brother's graduation.  Throw the ball around with it every once in awhile.  (Okay, maybe not that last one.)  Sure it's weird, but I am a woman of my word.


But that's not all!  Although it's unlikely, I realize that there may be a few people who are more interested in viewing photos of my day spent observing a CRNA in the OR than my tee-shirt (really?).  Regardless of your screwed up priorities, I've included more pictures below for you to peruse.  Enjoy!