I hope you enjoyed following me through my journey from an RN to a CRNA! Hopefully this has been a helpful site for new SRNAs, or anyone considering becoming a CRNA.
To continue following my journey as a new CRNA, please check out Health & Hypnotics
December 9th 2014 = BEST DAY OF MY LIFE!!!!!!!!
What a relief!
Everyone wants to know what you did to study, and I searched and scoured the internet, nurse anesthesia forums, etc to find the best ways to study. Well, I have to tell you that I decided to just go all out. I knew that I only wanted to take the test once. I wasn’t interested in seeing “what I could get away with” as far as the minimum amount of studying needed to pass boards. I needed to pass on the first try (I had a huge world trip planned December 18th!)
What I did was, I split up a LOT of this over the last month before boards. I probably should have started that sooner, if I could do it all over again. For example: I would say, ok…in order to be “ready” to test by December 5th (that was our graduation date, and the first day we could schedule our exam) I need to do 9 pages of the condensed valley modules, 30 powerpoint slides, 25 pages of the memory master, and 1 prodigy test every day – just an example. It made it more manageable, and you got to work on a little bit of everything everyday instead of tackling the entire memory master in a week, and ignoring prodigy.
I was nervous (duh) going into the testing center, but I felt like there was NOTHING else I could have done to make myself ready. So, gotta take it right? I sat down and started going through questions, and felt GOOD. There were for sure a few that were “WTF?!?” and I would just give it my best shot. But I would say that I felt confident in the majority of my answers, and when the test shut off at 100 questions…I was just praying that my “gut feeling” was correct.
YAY!
Well…I have a LOT of updating to do! My whole goal in keeping this blog was to give an “insiders” perspective to those considering CRNA school, those who have been recently accepted into a program and are anxious, and for those closest to me to keep up with me when I most likely wouldn’t have time for a long phone chat.
Clearly, I haven’t been very good about blogging!
So, in an attempt to redeem myself and keep good on my word – I am going to update this now as best I can.
My pediatric rotation was amazing. After the first month, I felt much more comfortable and really enjoyed doing pediatric cases. I’m sure much of that has to do with my pediatric ICU background, I felt really comfortable with handling little kids and putting in small IVs, etc. Little kids are also so FUN! Distracting them when you bring them back into the operating room is key, and they are so honest and real with their fears. Playing games like “blowing up the green balloon” or singing into the microphone (face mask) were great tricks.
I came home in August and spent a month back at my primary clinical site, which was like returning home. It was nice to come back and see those familiar faces again, and work with those encouraging CRNAs that I love; but at the same time returning to an environment that restricted me (compared to other out rotations) was disheartening. You learn by making your own mistakes decisions. Not much I can do about it though, so I had to just brush it off.
TRAUMA
September was my trauma rotation at a different hospital in town. Thursday, Friday, Saturday, Sunday nights from 7pm-7am. I worked nights in the ICU and loved it, so I wasn’t too concerned about the hours. The only real pain was we have class in the middle of the day on Thursday. So, I would try and sleep in Thursday, go to class, come home and sleep again until going into the hospital. Didn’t really work that well. After the first night it wasn’t so bad – mainly because I would come home exhausted, take 50mg of benadryl (and 400mg Mg) and pass out until I had to get up and go back again. The rotation was pretty good – I probably got a handful of real traumas that I got to be a part of. There was always an attending, a CRNA, and a resident on at night also. We all acted like a team when the trauma would come in, working together. Stabbings, car accidents, hypothermic cardiac arrest, and OB emergencies (ovarian torsions). You always needed to have the trauma room setup and ready to go. Emergency drugs ready, syringes put together so you could draw up drugs quickly, anesthesia machine ready to go, rapid infusers for blood products and getting IV fluids in real fast had to be all setup and ready. That really makes things run a lot smoother! We would also do add on cases (shooters abscesses, lap appys, lap choles, ortho emergencies) at night. When nothing was going on, we could “sleep” in the pre-op area on a gurney if we wanted to (we had a pager that would go off if we were needed, and they always had our cell phone to be able to contact us also). I mostly studied for boards, I brought my Valley review and Memory Master and worked my way through those during my downtime. It’s hard to sleep on a gurney, especially when that pager goes off and scares the living daylights out of you!
OB
October was my OB rotation. Hands down, I probably had the BEST OB rotation I could have hoped for, in terms of experience. I was dubbed the “black cloud”, ha! Our OB rotation is all CRNA run (there is an attending assigned to OB that is available for backup during like crash C-sections, etc). Our hours were 12 hour shifts, M-F (7a-7p). We still had class on Thursday, but left the OB deck to go to class, and then returned to finish out the day. I’m sure just having those hours gives you a good experience, but I hardly sat down. It was so busy! I got a lot of epidurals under my belt, and felt comfortable doing those (and spinals for C-sections) pretty quickly. C-sections, once you do enough of them, are kind of like the same routine over and over again for the most part. You come in the room, do the spinal, lay them down, treat their blood pressure, and do LOTS of reassuring that everything is ok. Before baby is out, keep the blood pressure up. Once baby is out, make sure you do whatever you can to help mom’s uterus contract. Again, lots of reassuring because apparently (I don’t have kids) it is a very weird sensation when they flip the mom’s uterus out. When putting in an epidural, I did get one wet tap (SO SAD). For those of you who don’t know what that is, it is when you are trying to do an epidural…and you go a little too far and puncture the dura with the epidural needle (which is what you want to do if you are giving someone a spinal for a c-section…but not if you are doing an epidural, the needle is too big). When that happens, spinal fluid gushes out everywhere and….yeah I was pissed at myself. The CRNA I was with did tell me that he would have “wet tapped” her too, because of her unexpected anatomy.
Despite the great experiences I had as a student (never boring) I hated OB. Most people in my class said they LOVED OB! I kept waiting for it to get better, or for me to like it…but no I’m really just NOT into OB at all. I guess you can’t be expected to love every area of anesthesia! I think part of why I hate OB is because the rotation was 100% OB, 60 hours a week. That’s a lot of hormones to be around…a lot of whiny women in pain (I know that sounds insensitive, but it wears on you)…for a whole lot of hours a week. I was so exhausted. Not to mention that OB is so different, it is an entirely different world – not everything is scheduled. They call you when they want an epidural, or you get called when “baby isn’t looking good” and we have to go to C-section. Your patient isn’t asleep (unless it is a crash C-section), so you are doing your job plus trying to reassure Mom plus chart everything you are doing, and C-sections aren’t very long!
RURAL/CRNA-ONLY
November was my optional (I am SO HAPPY I got chosen to go here!) CRNA only rotation in West Texas. I wasn’t so happy that I was going to have to be away from my husband and home for another month, or that I was going to West Texas (isn’t it all oil?) but I was happy that I was going to be ending my anesthesia school experience with a BANG. I was going to get experience with blocks (residents took those at our primary clinical site, so I had yet to do one) and more importantly I would be getting a ton of independence. The hours weren’t bad, especially since I was just coming off my 60 hr/week OB rotation. We rotated between two hospitals, an outpatient surgery center and the main hospital. I got experience with femoral, axillary, and eye blocks (wild!) but honestly the exposure to a practice that is CRNA-only was priceless. You are treated with respect by the surgeons (I had one actually thank me and I didn’t know what to say!). There was an anesthesia lounge with hot meals catered throughout the day, bottled water, juice, milk, cookies, WHATEVER. You ate lunch with the surgeons. Just a whole different vibe. I got to put people to sleep without anyone around (well, a CRNA would be sitting in the break room…who I could call if I needed help). It was just NICE. I can see how people who practice in this sort of setting would have a very hard time adjusting or enjoying being in a different setting.
This was the one time our school covered our housing ($1000!) which was nice. I stayed in a 2 bedroom 2 bath place with another student coming in from Arkansas. Luckily we had known each other a little bit during the time we spent in Fort Worth the first semester. So that was nice to have a buddy to study and hang out with. We really didn’t get out to do TOO much while we were there, mainly because I had an agenda to be ready to take boards early December. I studied SO MUCH in Odessa, which was perfect. I mainly used Prodigy while I was there – going through the study plan and taking tons of practice tests. Every weekend I basically would study all day, taking a break to work out, and then we would usually hang out at night – sometimes with three fun TCU girls who were also on rotation there during that time!
I left home in May for my cardiac rotation in Alexandria, Louisiana. People always ask why we have to go to so many different rotations, different states, ALL across the country it seems. It all has to do with what contracts the school has with what hospitals. It would be SO NICE if our school had a contract with the pediatric hospital that is RIGHT across the street from where our primary clinical site is, but that isn’t the case. Our primary clinical site also has medical residents training there, and they always have residents rotating through the cardiac cases, which is one reason we have to rotate out for cardiac anesthesia.
I hate driving long distances, and I hate driving on the freeway. Like really, really hate it. I think I have been in too many car accidents. Anyway, I flew to Louisiana (instead of driving) and was able to stay with my classmate, his wife, AND their two puppies for the month. That made it so much easier to be away from home, and I for sure was a lot less lonely than I would have been otherwise. It is just nice to have people around. I was so nervous to go to a new hospital! For the last 9 months I have been at the same hospital, working with the same CRNAs, anesthesiologists, and surgeons….and I feel comfortable there. What if the people there expect a TON out of me? What will the hours be like? Am I going to be overwhelmed? Way too many things to stress about. Luckily, the people there were great. They didn’t expect you to know how they did things right away. They were all very laid back and friendly. The way they do anesthesia is….different. Very sloppy, but maybe that’s because 99% of the anesthesia group is male? I don’t know. Being around mostly men does make for what seems like a drama-free, fun workplace (what is that?!?!). I did have to get there pretty early if I wanted to get a chance to put in central lines and a-lines. Like…waking up at 4:30 a.m. Ew. Luckily, I had a few days when the cardiac rooms ended early, like 1pm and I was able to go home early, which I am not used to at all! I felt like overall, I had a lot more free time in Louisiana than usual. I found myself having tons of time to workout, study, and relax at the pool. I even got to get out and explore the city a little…ok that’s a stretch. I did get to eat some crawfish (meh), go through a drive-thru daiquiri shop (brain freeze!), and spend a weekend with my husband in New Orleans. I left learning a lot about cardiac anesthesia, and feeling comfortable with the process. Who knows if in my career I’ll be doing much cardiac anesthesia, but I felt like I got a great experience.
Swamp along the running trail. No alligators (hopefully)
Of course once I got comfortable there, it was time to move on to my pediatric rotation in Kentucky. This time, I was a lot less nervous. Probably because my classmate Ashley came with me, so we would be fumbling along together figuring this new rotation out. I probably also felt less nervous because my entire ICU background (7 years) was in the pediatric ICU. So, I was looking forward to this rotation for sure! We had one day of computer charting training, and then 1 day of orientation (showing us where everything was) and then on the third day…we were basically thrown to the wolves. They said they would pair us with a CRNA for the first week, which made us feel less nervous. That….didn’t happen. I was initially paired with a CRNA for my first day, and as I was starting the first case with her, an anesthesiologist rushes into my room and says he needs me to start a different case. He and I rush to start this case, put the patient to sleep, and then HE LEAVES. Did I mention this little person is 9 months old and has a rare genetic disorder? Great. I’m freaking out a little bit inside…just being very hyper-aware of everything and knowing that if I need anything, I have his phone number. Turns out, the rest of the day went the same way. And the day after that….and the day after that. We are treated like CRNAs, running our own room with an attending. While it was ridiculously scary the first day that happened, it is also very refreshing to see that someone can have that kind of trust in us. I actually feel respected here, which is sad to say that I don’t necessarily get that feeling during a typical day as a student. Sure, we are basically free labor, but in return we are being given independence to make our own decisions (and mistakes).
I had my first pretty serious pediatric emergency the other day, and I won’t ever forget it. My attending said when the surgery was over, to go ahead and pull the LMA (airway) deep and take the patient to recovery. Well, when I did that basically the patient had an immediate laryngospasm (her vocal cords shut and I could no longer give her any oxygen/breathe for her). Her oxygen levels started dropping pretty fast, and I had the operating room nurse call overhead for someone to come in and help me, like STAT. Luckily, I had broken the spasm by the time everyone ran into the room, but it just reminded me that you have to always be ready for that kind of shit to happen, and know what to do, and to call for help earlier rather than later. I’m never going to be embarrassed to call for help, because it’s not worth it to try and be a hero in that kind of situation. Still, I skipped the gym, went home and had a big cocktail. Thanks little brat.
I’m definitely starting to feel homesick now. I’m ready to be back in Colorado with my husband and our pets. Living with Ashley has made this whole Kentucky experience enjoyable for sure! It’s fun having a roommate again; especially since we both have never been here so we get to explore the city together. We signed up at the YMCA and have been working out almost every day after clinical, and have been cooking every night since the ONLY thing to eat in the entire hospital is McDonalds! Can you believe that? We have a whole list of recommendations from people at the hospital, bartenders, etc. We have been on a trolley hop downtown, a flea market and art festival. Hopefully we can entertain ourselves long enough to make the time here fly by just a little bit faster.
175 more days of this. It’s getting closer…
Has it really been 6 MONTHS since I last posted? WOW. Talk about an excellent indicator of how much time I have had lately. I just looked at my case count, and I have put 352 people to sleep! I don’t even know how to explain what has happened in the past 6 months. I’ve stayed at the same clinical site the entire time, which has been nice to be able to feel confident and comfortable with giving anesthesia in the same setting. At the same time….I’m ready to move on to my specialty rotations. I kind of feel like after giving anesthesia at the same hospital for 7 months, 55 hours a week, unpaid…well, it’s beginning to feel like abuse enough already. I have gotten a lot out of this clinical rotation, and am ready to see what else is out there.
In May I’ll be heading to Louisiana for a month for my cardiac rotation, then in June and July I’ll be in Kentucky for pediatrics, which I am most excited about since that has been my passion from the start of my nursing career. I’ll be back at my primary clinical site in August, then in September/October will be heading across town for trauma and my OB rotation. My last out of state rotation will be in November, when I’ll be in West Texas for a CRNA-only, rural practice which will hopefully tie things all together, and by that time I should feel like a well prepared, independent practitioner (right?).
I’m certain 
that you can’t accurately describe the clinical part of anesthesia school to anyone. It’s almost like you can’t fully understand it unless you are IN IT…like only other nurse anesthesia students really get what you are going through. I can try and describe it to friends and family, but it is honestly something nobody could really even explain to me. The girls I am in clinical with right now are the only ones who first-hand experience everything I do. It’s like a horrible, secret club you didn’t know you signed up for. I keep trying to come up with the best way to describe what it is all about, but it’s impossible. 55 hours a week (which I didn’t realize is a LOT OF HOURS), being treated like you are a five year old, yet you are expected to know everything. #fakeittillyoumakeit
My days have been very up and down. Now that I have the hang of the general cases for the most part, my CRNA will leave me to handle the anesthetic pretty much however I want to. That kind of independence gives me confidence, and lets me make my own decisions (and mistakes). Those moments when I’m sitting in in OR, all alone, for > 50% of the surgery…giving drugs and managing the patient independently…makes me so happy. It is like seeing a little sliver of light at the end of the tunnel…like there is an end in sight, and it is a career that I’m going to love. Those moments really are what keep me going. Recently, I had a PACU nurse tell me that ALL my patients that day had woken up “beautifully”. She didn’t have to tell me that, but it was the nicest thing I had heard all week, and I left the hospital that day feeling positive and proud of my decisions that day.
I know th
at I still have a lot to learn, and that there is SO much I can get out of listening to the advice of others, and I don’t take that for granted. I do believe that some people are just not meant to teach, and that’s ok. I’m trying to recognize that and not take it personally when that type of person micromanages every single step of the anesthetic, and makes you feel like a piece of shit stupid but that sort of day can really put you in a sour mood. Those are the days when I come home and just want someone to wake me up when this is all over. 254 more days.
My first thought when I realized it has been a month since I started giving anesthesia, was that I can’t believe how far I have come in just a month! The first couple weeks I remember thinking that it was so fast paced, and there were so many little details to remember, that I couldn’t wrap my head around how I was going to be able to get it all down. While every case and surgery is different, and every CRNA we work with does things slightly differently, the general flow of how it all happens is pretty consistent.
Now I feel like I am able to walk up to the patient in pre-op and do my own assessment (ask them key questions about their health history, do an airway exam, etc) without forgetting anything important. We also are responsible for getting consent for anesthesia (which is separate from the surgical consent) and that part everyone does so differently. I really liked how one CRNA I was working with does her consents, so I have pretty much adopted that one as my own. I sit down next to them and pretty much go through step-by-step what to expect. Here’s my general speech I’ve come up with:
“Ok, so we are planning on general anesthesia for you, which means you will be completely asleep for your procedure. When we are all ready to go, I’ll come out here and give you a pre-medication which will help you to relax and also works to prevent you from remembering anything. Kind of like a happy hour cocktail (then they laugh). We will bring you back to the operating room, and have you move onto a different bed. We will put monitors on you, and I’ll give you some fresh oxygen to breathe from a mask. What we are doing is trying to fill your lungs with as much oxygen as we can before we get going. Then I’m going to give you some medication in your IV which will drift you off to sleep. Once you are asleep, I’m going to place a breathing device in which will help protect your airway. You won’t remember me putting it in, and I will take it out before you are fully awake. I will be taking care of you the whole time, watching your blood pressure and giving you medication for pain and to prevent nausea. Before you know it, you will be in the recovery room. If you have pain during that time, please let the nurses know and they will be able to give you extra pain medication out there.”
This next part is the part I hate saying
“With anesthesia and surgery, there are always risks. We can cut your lip or chip your teeth when trying to put in the breathing tube, and we are very careful to avoid that, but I have to let you know that it is a risk. Corneal abrasions are another risk, and we try to prevent that by taping your eyes after you are asleep. When you wake up, your eyes are going to feel sticky from that tape, and you are going to want to scratch your eyes. You will hear us tell you to not touch your eyes and that is because you might give yourself a corneal abrasion. The most common side effects from anesthesia are a sore throat from our breathing tube, and nausea and vomiting. We will give you medication that will decrease any throat swelling, as well as anti-nausea medication to try and prevent that. You are very healthy (if they actually are), and I don’t anticipate you having any serious complications from anesthesia, but I have to tell you that they exist. These include brain damage, heart attack, kidney failure, and death. Your odds of getting into a car accident leaving the hospital are much higher than your odds of experiencing any of those. Do you have any questions for me? Here’s our consent form which outlines all the risks I’ve already told you about, and we just need you to sign right here if indeed you agree that you would still like to be asleep during the surgery”.
I mean…they know that there’s a risk they might not “wake up” but I just hate to be the one to say it! One CRNA I was with said you get over being blunt and saying “death” pretty quickly. They know it is a risk of surgery/anesthesia, so it shouldn’t be a shock to them when it comes out of your mouth.
Man, people are CHATTY after you give them versed! It is like liquid truth serum! They get real friendly and start just talking away like you are their best friend. It is pretty funny, and they are never going to remember what they said either. A lot of people wake up and are like “god i hope i didn’t say anything embarrassing” and of course I always tell them they didn’t. 🙂
I feel like I’m getting used to the long hours and getting up early. Lately I’ve been getting faster at getting myself ready in the morning (and my OR room) so I’ve been getting up at 5:10am instead of 4:45am, hooray! I think the part that annoys me the most are all the “extra” things we have to go to like conferences and seminars, etc. that make our day THAT MUCH LONGER. They just make me tired and put me in a horrible mood. Maybe if I had anticipated that from the beginning it wouldn’t annoy me so much, but when we are done giving anesthesia at 3pm, then we have to look up our patients for the next day, which varies in how long it takes me depending on how many cases I have, and how sick the patients are. Usually its around an hour or so, +/- 30 min. Then having to stick around for a conference for 1-2 hours a few times a week is annoying. Mainly because if they go too late I can’t make it to Crossfit in time, which makes me cranky.
I figured I’d include some non-anesthesia photos for this post. Grace has been keeping me entertained. We taught her how to say “you CRAZY” but now she is getting lazy with it and just says “you CRAY” which makes us laugh even more.
Today we found a butterfly out on our patio that was BEAUTIFUL but also couldn’t fly anymore 😦
I’ve been sharing my notes with a group of my fellow classmates over the past semesters (these are notes that I had basically been making for myself to study), and they have found them to be pretty helpful along the way. Over the summer break, the Denver and Arkansas groups surprised me with gift certificates to our favorite restaurants! That was such a sweet surprise, and they clearly know I need a night off! Steve and I are headed to Cool River Cafe tonight for date night!
Here’s to hoping it keeps getting better every month! So far, I’m convinced I’ll have the best job ever. 🙂
Well, according to Typhon (our case-logging program) I have given anesthesia 43 times, intubated 26 people, and have spent 141 hours in the hospital so far (93 in the operating room)…in 12 days.
I love it. I’m *almost* afraid to say that…as if that might jinx me!
Talk about a steep learning curve. At least we have 15 months to figure it out! The CRNA I was working with on Friday said that by the time the holidays roll around this year, I should feel like I’m starting to get the hang of it. Then another CRNA said that once I’m 9 months into it, I’ll stop being constantly petrified that I might kill the patient. They know we are being hard on ourselves. I have to remind myself that I have only given anesthesia for 12 days which is nothing in the grand scheme of things! I can’t expect myself to be super smooth with my pre-op assessments, or to be efficient and quick with the charting. I”m not going to get every single intubation, and I”m going to do some dumb things….like tell the patient to breathe into the mask, without remembering to turn the oxygen on! Jeez. Everyone I’ve worked with gets it, they know we are just starting out and I think still remember being in our shoes. However, I must say that I feel slightly better every day that I go in there. It’s like “oh, I’ve seen this before” and know what to do, or what to expect. I’m less surprised when my patient’s blood pressure tanks after induction (and now I just expect it) because that’s what happens. You just give them a pressor to hold them over until the surgeon gets going and stimulates them enough to bring it back up.
I feel like I’m getting better with the general flow of the typical OR case, which makes me feel less overwhelmed. I’m sure it is like anything, and the more practice and the more times you do the same(ish) routine, the faster and more efficient you will get. It is hard when you train with different CRNAs everyday, because they all have a slightly different flow of how they do things. At the same time, it is nice to not just learn one way to give anesthesia…since some people have taught me things that seem to work a little better than the person who I was with the day before. I really liked that one of the CRNAs I was with taught me how to mix up my own phenylephrine syringe. We have them stocked in our cart and she said the worst thing you can do is rely on the fact that you should have a few in there…what if you use them all up? You need to be able to mix one up yourself from the vials in the cart. So that was really cool.
I have been spending a lot of time in GI where they do a ton of endoscopies and stuff like that. The cases are very quick (and you will do like 5+ a day) but it makes for a lot of repetition which is good for my confidence, and a lot of intubations and airway practice. I have a new appreciation for patients who do NOT have beards/mustaches! I swear it makes it 5x as difficult to mask ventilate and to intubate them when they have this big bushy mustache obstructing your view! I can’t tell you how many times I’ve had to ask the CRNA I’m working with to flip back this guys upper lip for me when I’m trying to find their vocal cords! So far I think I’m liking the Miller blade, with the short stubby handle the best (well, the glidescope is by far my favorite but that’s kind of cheating). They say you need to get proficient with both blades obviously in case you are in a position where only one kind is available…so I plan on alternating depending on which one my CRNA of the day likes, although I guess the Mac is supposed to be easier to use. Who knows! Why can’t everyone’s vocal cords look like this?
Overall, I’m really liking all of it. We are definitely getting a good experience, as exhausting as it is. It is so cool to see all the things we spent a year learning about in school “come to life”. It’s nice to know that all the things I spent hours learning are actually useful! I have NEVER looked forward to the weekends like I do now! I actually feel like I have more time than I did during the first part of the program when I studied so much. My weekdays are definitely shot…if I’m lucky I can spend an hour with my husband and/or maybe an hour working out, but the weekends are wonderful. I’ll do one careplan, which does take a few hours…and spend an hour or two studying the material from class that week, but that’s about it. Not 8+ hours each day studying, so that is really nice. I’m also getting used to the early bedtime that’s required…
Speaking of that, it’s time for bed!
Wow. Where do I even start? I just realized it has almost been an entire year since I have updated this! The time has certainly flown by (somehow even found time to get married!) We finished our didactic (classroom) portion at the end of July, and had our last final (much needed) 3 week break, and this week was the first week we were giving anesthesia in the hospital.
The classroom part of the program was intense. On average I probably spent 10 hours a day studying, outside of the time we were actually in class (18 hrs/wk). However, it was one of those things where I feel like if you were able to dedicate yourself and put that time in, you could do it. So, not impossible. The nice part of it all was that I was able to return back to Colorado in the middle of December and live with my husband again. He has been amazing. I am so lucky to be with someone who understands the time commitment and the stress I’m under. He has been so supportive and picks up all the slack since I have to devote so much time to school. I don’t know how he does it!
To sum up this first week of clinical with one word, I would say….exhausted. I honestly didn’t think I would feel this worn out, since I used to work nightshift and functioned well on not-so optimal sleep! I’ve been taking Benadryl to get and stay asleep, and have been using visine daily. I can only hope it will get better as I become more comfortable with what’s expected of me
So here’s a typical day. Wake up at 0440, get dressed/coffee/breakfast and be out the door by 0510 (which always ends up being 0515). Get to the hospital by 0530 and in the OR by 0550 after parking, walking, changing into scrubs. Then I have to check my anesthesia machine. It’s kind of like when a pilot checks his plane before take-off, it has to be done super systematically so you don’t overlook anything. Then I draw up all my emergency drugs and put them in a little corner on the anesthesia cart, and make sure I have all my airway equipment for the first case. This includes a pre-calculated drug dosing index card for my first patient (which I made the night before) so I can just glance up at it for the doses when pushing drugs. Then it’s probably 0645 by now and I can go to the pharmacy and get my bag of narcotics for the first patient, and usually this is when the CRNA that I’m working with for the day shows up. We have to be in the pre-op holding area meeting our first patient by 0700. Usually they are already there, since the first case is typically at 0730. Then we give anesthesia basically non-stop/back to back until 3pm-ish. Then I look up my patients for the next day (what they are having done, their history, meds they are taking, etc) and typically am out of the hospital by 5 or 5:30pm. Then we have to go home, look up what kind of procedure they are having done, and come up with an anesthetic plan personalized for them. We then call our CRNA that we are going to be with the next day and discuss those plans with them and see what they think. Then, log into the case-tracking software and plug in all the cases we did today to get credit for those, and then GO TO BED. This week was rough and I didn’t do such a great job of making sleep a priority. I’m going to shoot for 9:30 this week, because going to bed at 10:30/11pm isn’t working!
That’s 5 days a week…. and on Tuesdays, we leave the hospital at 11:30 to get to our class from 1-3pm. Then, we go back to the hospital to a conference from 3:30-4:30, then look up our patients for the next day. Starting mid-October we won’t be giving anesthesia on Tuesdays, and we just go to the hospital after class to look up our patients for Wed. Hopefully the classroom portion won’t require tons of studying (because it’s not going to happen!). I have never looked forward to weekends more in my life!
New toys! I’ve got a new stethoscope, stopwatch, some goggles, and I made myself a “brain book” as a quick reference. My husband also bought me an ipad mini which I’ve been bringing along in my OR bag which has all my anesthesia books loaded onto it.
My first intubation was hilarious. I was shaking like a leaf, all flushed and sweaty, even though the CRNA I was with said he would push all the drugs and walk me through it. The anesthesiologist we were with got a kick out of my discomfort…You are supposed to put them in a “sniffing” position with their head tilted back a little, and I forgot to position the head that way, so when I went to look for the trachea all I saw was pink tissue. Great. After a few attempts at looking, taking a break to ventilate the patient, looking again, I finally saw “a hole”. I put the ETT in there and we hooked it up to the anesthesia machine…and it was not in the trachea. Totally in the stomach. DANG. So, we pulled it out and I looked for a last time and finally saw the vocal cords. They were WAY more anterior than I thought they would be. So, now that I could see where I was supposed to go, I grabbed the ETT (picture me grabbing it with a fist) while the anesthesiologist just sat and giggled and told me I shouldn’t grab it like that, that I look like I’m about to jam it into the throat. I asked him if I should put my pinky out (like holding a cup of tea)….that made him laugh! In the end, I got it in the trachea….but shoved it in 4cm too deep, and we had to back it out some. Hey, I wanted to make sure I was in!
This week in total I got 4 intubations! The 3 that followed were much smoother. I’ve learned to lean BACK to get a better view. They tell you that in school but I think it is just natural to want to put your face right up next to where your hands are. It totally doesn’t help at all, you actually see LESS. So, hopefully I can remember that. I also need to work on sweeping the tongue better, and remembering to put the blade in further than I think I should. So far I’ve just used a MAC 3 blade. They say you should try to use the same blade for a month or so, and then switch to make sure you are good at using both in case you get called to intubate and they only have one or the other available.
As far as everything else goes, it is overwhelming. I feel like this is the ultimate multi-tasking profession. You have to remember to chart everything (on time) while keeping the patient stable, and then in the middle of your case you should be thinking about what you need for the next patient, and getting those things ready. I think for the quicker cases it can be hectic and you have less time compared to longer cases. I’m sure as I get used to the flow of it all, I’ll feel better about it. It’s just hard when EVERYTHING is new and you are trying to grasp and really understand it all. Plus, everyone does it a little differently and we are learning from multiple people. I think it is great to see all the different ways that anesthesia can be done, but it is a little hard right now with the steep learning curve!
Everyone has been very nice so far, so I feel lucky. I know there will be days when I’ll get yelled at or someone will tell me I’m an idiot, and I know there will be days when I mess up and beat myself up over it. I’m just trying to be a sponge and soak up as much as I can while keeping a positive attitude.
466 days to go!
WOW! Where did the time go? I can’t believe it has already been 5 weeks since we first started the semester!
I’ve certainly been taking it one week at a time. It has been quite an adjustment! Luckily, it hasn’t been THAT long since I have been “out of the game” as far as school and studying goes, but this is a whole new world. I have never been the type of person who can look at something once and learn it. Repetition has always been key as far as getting it to stick. As I expected, I had a game plan set for how I was going to tackle studying and staying on top of everything, and I have had to adjust my strategy here and there, and I’m sure I will continue to adjust things as I figure out what works the best and is the most efficient use of my time.
Grace is helpful too 🙂 
So far, I’m doing very well, AND even enjoying it! My studying strategy has seemed to keep me from falling behind in any one of my classes. We have a test every week now until the end of the semester (each class alternates which week they test in, so its not like an exam every week in every class). Our first exam was our A&P class, which I think everyone in my program studied REALLY hard for. Not only was it our first test in grad school, but we had been told (multiple times) that most people fail this test. It was basically a very detailed look at the cell. So, we all studied like crazy. I did know it was important NOT to fall behind with my other three classes, as our teachers say doing that is the “kiss of death” since we have a test every week. You can’t just give up studying/reading on all three of your other classes to focus on one, which makes sense. I ended up getting a 90%! (Which by the way is NOT an A, 91% would have been…grrr) Regardless, I could NOT have been happier with how I did!!
Here’s a whiteboard drawing my friend Ashley made that we went over and made sure to know really well. Kreb’s Cycle!
Our second test was in Advanced Pharmacology. Our professor talks SO FAST. He covers so much material in 2 hours it is insane! This ended up being a harder test (which the rest of my classmates agreed!) It covered kind of the basic features of pharmacology, and there were a lot of math and dosing problems. I ended up studying really well for this one too, and scored a 97%! (THAT is considered an A!) Our last test this week was today, in Chemistry. Acids/bases, salts, and general chemistry. He gave us a pretty nice curve, so while I really earned a 92%, it ended up being 102% with the curve. SWEET!
So, after our first tests in all our classes (we don’t have tests in our Ethics class, just one final, and two group projects) I’m feeling pretty good about everything! It seems like my strategy is working. Basically, I’m doing a lot of re-watching of the lectures. They video record every lecture and then post it online for us to re-watch as many times as we need to. This is proving to be REALLY helpful, especially since our days are so long and we get a lot of material thrown at us. So, I’ve been watching those back, writing detailed notes, and then making online flashcards to quiz myself. Steve suggested getting a second monitor, so I can re-watch lectures on that screen, while typing notes on my laptop. So much more convenient! I got a huge whiteboard so I can draw diagrams from memory too. I’ve been making sure to know the material well enough to basically be able to write a short answer/essay on every topic. I figure if I know it well enough to teach it to someone else, then I’ve got it down.
For my birthday this summer, Steve said he would pay for me to try out CrossFit, since it is something I have wanted to do for awhile now, but it has always been too pricey to try out. Since I would be in Fort Worth and gym-less, he figured it would be a perfect time for me to give it a shot. Of course…now I am hooked. 🙂
Here’s a good video I found that explains what CrossFit is all about!
It is SO challenging. I don’t think I have ever pushed myself this hard before. It is basically like having a personal trainer (but they are training like 5-10 of us at a time). The workouts are short, and really intense – and I think what I like the most is that the movements you are doing are all functional, and I walk out of there feeling like I got run over by a truck! Haha! Plus, there’s someone there to coach you through the lifts that require coordination (something I need serious help with!) All the coaches and people that go are so supportive too, and so friendly! Some of the workouts are you against the clock, and some of them you are paired up with a teammate racing against the others. There’s a great mix of high intensity cardio with weightlifting. It kind of reminds me a lot of soccer, or being a part of a sports team. Hopefully when I go back to Colorado I can find a CrossFit there that has a similar environment! It has been such a nice escape for me when I start to feel like all I do is study and study and study….
Tomorrow is my first lab day, so I get to go play with the anesthesia machine with a small group of people for 2 hours. I’m not sure what exactly we will be doing, but I’m sure it is skill work – kind of like when we learned to put in IVs as nurses. Maybe I’ll even get to practice intubating a plastic fake person! Count backwards from 5….4…3…
Well, I made it through my first day without feeling completely lost or overwhelmed. That’s a start! Yesterday I logged onto Blackboard and saw that our professors had listed some of the material we would be covering the first day of class, some of their powerpoints lectures, exam dates, etc and so I thought I would get a head start and read before the first day of class, and made up my study schedule for every day so I would be prepared for the material that would be covered that day in class. I read and took notes and made up this whole study schedule (color coded of course for each class) and thought “wow, I’m probably going overboard….class hasn’t even started yet”. Come to find out, pretty much most of my other classmates DID THE SAME THING! So…I’m not the only neurotic one. 🙂
This week we meet from 8am to 7pm. 11 HOURS! Starting next week, it is 9am-7pm which will be nice, and after 10/31 it is 12-7pm. Ethics was our first class of the day, which seems like it will be an interesting class, but not heavy on the studying. Our Chemistry class seems pretty straight forward, and I took his refresher class in the Summer, so I kind of know how he runs his class and what to expect. I know the classes I will need to spend the most time/effort on are A&P/Patho and Pharmacology. Our A&P professor was the one who grilled me during my interview, so I kind of went into the class a little intimidated. I was so relieved when he spent a good 10 minutes talking about how his class is not intended to “weed out” students, and that he really does want everyone to pass (but at the same time know our stuff). It really made me feel a lot better about his class, and the program in general. I know it is going to be a lot of work, and demand a lot of my time, but it is do-able.
After a long day, I’m exhausted!
rn2crna 
