Monday, Monday
So good to me.
Monday, Monday
It was all I hoped it would be.

Oh Monday morning
Monday morning couldn’t guarantee
That Monday evening
You would still be here with me.

Monday, Monday
Can’t trust that day.
Monday, Monday
Sometimes it just turns out that way.

On Monday morning
You gave me no warning
Of what was to be.
On Monday, Monday
How could you leave
And not take me?

Every other day
Every other day
Every other day
Of the week is fine, yeah.

But whenever Monday comes
But whenever Monday comes
You can find me crying
All of the time.

Monday, Monday
So good to me.
Monday, Monday
It was all I hoped it would be.
Oh Monday morning,
Monday morning couldn’t guarantee
That Monday evening
You would still be here with me.

Every other day
Every other day
Every other day
Of the week is fine, yeah.

But whenever Monday comes
But whenever Monday comes
You can find me crying
All of the time.

Monday, Monday,
Can’t trust that day.
Monday, Monday,
Just turns out that way.

Oh, Monday, Monday,
Don’t go away.
Oh, Monday, Monday
It’s here to stay
Monday, Monday
Oh, don’t go away

By Wilson Phillips

It is one of those Mondays. Maybe you don’t remember the Momma’s and the Papas but I seem to recall hearing this in the distant past some Monday. Just turns out that way, Mondays do. This Monday was not a day of crying but for going to school; Nurse Anesthesia school didactic and its here to stay.

Cardiac risk factors in the non-cardiac surgery patient are the topic of discussion today. This is a little complex for me so we turn to the ACC/AHA guidelines for a little help. I was able to find this document without too much trouble this afternoon. Here is the question, “do we go ahead with this ankle fracture surgical repair in this 55 year old Hispanic woman with a history of diabetes and hypertension and recent MI.” Oh, she had a myocardial infarction 4 months ago and currently has intermittent angina. Her blood pressure this morning is 165/90 and her medications include metoprolol, isordil, metformin and aspirin. She is able to climb two flights of stairs without getting too short of breath.

So what do you think? Are we ready to go to the operating room to fix her broken ankle? OK, we do this case being a little nervous with her potential to re-infarct again. Blood pressure and heart rate are well controlled during the anesthetic using opiods and short acting beta blockers. Cool, case one down.

The next case is an Armenian gentleman aged 54 who is scheduled for a fem-pop bypass graft (he has vascular disease even at this age), a heavy smoker for the past 30 years and a family history significant for coronary disease in both parents and an older brother. During the history he tells you that he is not able to climb one flight of stairs because his legs hurt too much so he can’t comment on whether or not he gets short of breath. No cardiologist has seen him. Do we take him to surgery today?

The ACC/AHA guidelines for Cardiac Risk in the non cardiac surgical patient can help with these kinds of decisions. Now maybe you thought this was all fun and games but when your butt is on the line and you have this guy’s future and health in your hands it makes you think twice, maybe more than twice.

As a student we are thrown into these situations and we have a clinical supervisor breathing down our necks asking us questions while we are trying to get organized and straight in our heads if we even want to take this guy to the OR. “So little grasshopper, why didn’t you call me last night with this information you worthless piece of student dog meat”. Oh No Mr. Bill!

Some of us are not getting very much sleep mulling all these things over trying to figure these things out, finishing up the anesthesia plan of care for the next days and studying for exams. This is not to mention that some of us have husbands, wives and children that need a little, I mean little attention once and a while. Maybe it’s the worry about how to keep our patients safe that bothers me the most. Even after all the study and diligence to make sure that every base is covered, there maybe just maybe something that will get overlooked that could make a difference. It keeps me thinking late at night.

Sometimes I wake up at 2:30 in the morning with my mind ruminating on the case that was a little difficult that last day. Wondering why I missed a couple of important points that my clinical instructor was “pimping” me about. I knew that stuff, why did I blank when he asked me all those questions. Maybe it was because I was trying to do something in the OR and my mind could not jump rope and chew gum at the same time, who knows.

All in all I am having a great time. Everyone is kind and understanding for the most part and it’s usually just me that is making life really tough. We are our own worst critics.

OK, did you think about our Armenian fellow. He is not going to surgery today. This is based on the ACC/AHA guidelines. He has intermediate risk factors and is scheduled for a high cardiovascular risk surgery and needs cardiology consult. Seems reasonable now while I am sitting at the desk with all of the data in front of me but in the heat of the moment it’s not so clear sometimes. I guess that’s why we are in training and have seasoned clinical anesthesia around to make sure we don’t fall in the ditch.