Uggggh! Test time coming this Monday and it’s hard to start reviewing. My brain is tired after a long week of OR time at LAC-USC. “Focus, focus, hocus pocus …. What ever it takes to get down to business and do the work that needs to be done to do well for this exam”. This is the self talk that goes on sometimes in the wee hours of the morning and long into the night. To become a CRNA is a lot of work, we all knew this when we started. Now is the crunch time.

How to stay focused. I don’t know if that is a question or the answer. What I do know is that this quality of tenacity and sticking to a routine is what has guaranteed success so far and what it takes to keep going. Once in a while as a student it is necessary to just breathe deeply and smell the fresh coffee, hold the cup in your hands and enjoy the moment.

This makes me think about the different kinds of runners. The physical characteristics of a sprinter, the shorter thick powerful explosive energy build into their frames are wonderful for the short sprint. Take a look at the long distance runners and the body habitus is very different. The distance athlete has the lenthy thin muscles and ability to keep churning out the miles. These guys are not so good in the sprint but after 10 or so miles they are warmed up and can really start to glide along the road. Being in this nurse anesthesia program is like that too. You have to find your own rhythm, the routine of getting up early, finding moments to hours to study; taking care of all of the responsibilities and finding your routine is like this long distance runner. The longer these runners go, the better they get.

That is the key for me today. Find my own rhythm and stick to it. I am not good at cramming just before an exam; its the daily flow of reading and clinical practice that works best for me. Now, I just to maintain that rhythm, at least until Monday afternoon.

Today is the Chinese New Years Day. Last night my wife and I went to Temple as we do every year to honor Buddha and pray for our living and deceased ancestors. For those that do not know these traditions I have included a little summary of these things.

Chinese New Year is a celebration season that starts with the New Moon on the first day of the New Year and ends on the full moon 15 days later. The 15th day of the New Year is called the Lantern Festival; this is celebrated at night with very large light displays and children carrying lanterns in the yearly parade.

The Chinese calendar is not a Western Invention as you may have guessed and is based on a combination of lunar and solar movements. The lunar cycle is about 30 days in length. I say about because it averages to 29.5 days. In order to “catch up” with the solar calendar the Chinese insert an extra month once every few years (seven years out of a 19-yearcycle). This is the same as adding an extra day on leap year. This is why, according to the solar calendar, the Chinese New Year falls on a different date each year.

The Chinese New Year’s Eve and New Year’s Day celebration are family affairs. It is times of family get together, reunion and thanksgiving. The celebration was traditionally highlighted with a religious ceremony given in honor of Heaven and Earth, the gods of the household and the family ancestors.

The sacrifice to the ancestors, the most vital of all the rituals, united the living members with those who had passed away. Departed relatives are remembered with great respect because they were responsible for laying the foundations for the fortune and glory of the family. To the Chinese these things are primary. I have enjoyed participating in these celebrations because my wife is Chinese and I have become such a part of her family.

The presence of the ancestors is acknowledged on New Year’s Eve, last night, with a dinner arranged for them at the family banquet table. The spirits of the ancestors, together with the living, celebrate the onset of the New Year as one great community. The communal feast called “surrounding the stove” or weilu is symbolized by family unity. This diner honors the past and present generations. In my own way I was able to remember my own parents and the contributions that they have made to make my life what it is today.

So, celebrate with us and remember your roots. It couldn’t hurt.

David and Jennifer

Studying anesthesia didactic is an arduous task. The achievement of foundational basic knowledge is the goal of every Nurse Anesthetist Student (SRNA). Between pathophysiology and pharmacology alone a mountain of information is piled very high that literally takes years to get comfortable with. For the SRNA becoming a competent practitioner requires lots of study time. Lots!

Valley Anesthesia Review to the rescue. The Valley Anesthesia people offer a review course that is designed to assist with the students’ studies and direct the focus for preparing for the National Certifying Exam for Nurse Anesthetists. The national organization for nurse anesthetists, the AANA, conducts the certifying exam for graduates of approved nurse anesthesia programs once the student has graduated and is prepared. So what does all this mean?

Today I received in the mail the 2005 Sweat Book from Valley Anesthesia. This is a thick review in outline form of much of the pertinent information that is at the heart of the Certifying Exam. Currently the first year students at the USC Nurse Anesthesia Program are studying pathophysiology and advanced pharmacology. In looking through the Sweat Book, this is what the Valley Anesthesia folks call it; I noticed that a lot of the detail of what we are studying now is covered. Great! I can study for current didactic and review for boards at the same time. How cool is that. Actually, the Sweat Book will help to direct my readings in other texts that are available. There is a very nice list of Anesthesia Text books listed here on the web site if you are interested.

The text that has proven most useful lately is the Robert Stoelting and Stephen Dierdorf edition, “Anesthesia and Co-Existing Disease.” All of the relevant pathophysiology and anesthetic implications for most conditions are elucidated clearly in this text. Co-Existing Disease is very cleanly written, precise and to the point as well as eminently readable. This is difficult for subjects that of necessity cover a lot of scientific material. There is a little handbook that is a companion volume for this text as well. It fits inside of a lab coat pocket nicely and carries well in the clinical arena. Again, very cool especially when doing preoperative assessments or looking up a disease process that should be reviewed before an anesthetic.

Valley Anesthesia Review course is booked! Several of my classmates have booked a trip back to Ohio for next fall. Yes, it is almost a year away but these classes fill up quickly. This will give us 6 months to review before our Certifying exam which will not be scheduled for about a year and one half. We have a ways to go yet you see.

I have been thinking of inviting several of my classmates to participate in this log of our journey through Nurse Anesthesia School. It could be something like a Travels with Charley saga, you never know.

This past week I spent time in the trauma OR room and Friday was spent in the hot Burn OR for two cases. We are adding up our cases, tallying our statistics on Medatrax, so that we can have a full experience as SRNA’s. The life of a student Nurse Anesthetist is too full. This week however, I had time for reflection.

The great thing and the bad thing about statistics is that they are so impersonal. It’s like hearing in the news that there were fewer traffic fatalities this holiday season, only 8 highway deaths over Christmas week down from 12 last year. Interesting unless you are related to one of the unfortunate tragedies. The trauma OR room is like that too except you get to see the results up close, too close really.

There was a case this last week that had me thinking for days; actually I have not stopped thinking about it really. Just another small statistic probably not even making any news but terrible never the less. An out of town woman was hit by a car and made it to the emergency room after being thrown 10 feet or so as the report reads. She was rushed to the OR for neuro-surgery after her level of consciousness decreased and her CT scan revealed active intracranial bleeding. I am use to taking care of these unfortunate victims in the intensive care units but this was my first experience with a large trauma in the OR.

It was pretty much a rush with 3 surgeons, an anesthesiologist the chief CRNA and myself helping out. As a student I basically took orders, started an arterial line and functioned at the head of the bed with the Chief CRNA behind me. We were all very busy. This person had multiple injuries, pneumothorax requiring a chest tube, fractures limbs and the head injury which was severe. What I keep thinking about now is this poor women and her family. At the time we were busy with her anesthetic and there was not a moment for reflection.

The surgery went well actually and the pressure in her brain was relieved. After the craniotomy her blood pressures settled down and we were able to keep her stable with titratable medications. As far as the general anesthetic was concerned, this also went fairly smoothly. She will need additional surgery for her other injuries but they can wait till the morning.

I went to see her in the ICU the next day. She was still intubated, sedated and seemed to be doing alright. She had woken up and moved all of her extremities but the nurses told me that they were not able to assess her neurological function yet. Seems reasonable and hopeful. Her family was coming from out of town. That all seemed so sad for me that this all happened. The one good thing is that she would have died had it not been for the quick abiltiy to detect her bleed and releave it. Maybe this strikes home to closely. Perhaps I will comment on that someday.

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