Learn from yesterday, live for today, hope for tomorrow. The important thing is to not stop questioning.
Albert Einstein

“Never regard study as a duty, but as the enviable opportunity to learn to know the liberating influence of beauty in the realm of the spirit for your own personal joy and to the profit of the community to which your later work belongs.”

Monday, July 4, 2011

Guess what i did for the holiday weekend

Yeah i spent the better part of my holiday weekend hitting the books. Yeah, everyone kept saying to stay away but honestly that was the time i had to catch up with my readings, assignments and stuff.

Anyways, lets talk about my assignments from last weeks. I got to do a bunch of sedation cases last week. For the most part, the sedation cases went very well actually. I had one really really sick patient who really bottomed out his blood pressure but we fixed him but he never desated. But our last sedation case was intense, this last patient was really healthy actually. No past medical history except for losing his/her voice and came in for an endoscopy to see what the problem was. Anyways, towards the end of the procedure the patient totally desated to the low 80s. We had the yell at the physician to stop the procedure ( this MD wouldn't stop no matter what we told this person) and we had to ambug this patient a bit to get the sats back up. WOW!!!!that was an intense moment.

Besides that patient, i had a really really sick patient who was getting a diagnostic laparoscopy and in the end this patient did great with anesthesia but unfortunately the disease metastasized and they MD decided not to proceed. It was a pretty sad situation. There's nothing else left to do.

Had a couple of breast cases as well. With these type of cases, you get a lot of PONV. So i tailored my plan to help with PONV. I suggest a propofol drip with the anesthesia (propofol has that antiemetic property) or a precedex drip (to reduce the use to opioids and decrease PONV). We ended doing the precedex drip.

One of my preceptors was especially hard on me this week. I'm really laid back and quiet and this preceptor is trying to beat the quiet out of me. And to be honest, its starting to work. Normally, if a preceptor said something i don't like i just swallow my pride. But this person was getting on my last nerve so i kinda told them off a little, not too bad and actually they took it pretty nicely. I guess that's what i needed to get them off my back.

I don't have my assignment for tomorrow yet. So as soon as i get it, I'll be working on my care plan tonight.

Good afternoon guys and have a safe 4Th of July

Peace out

Wednesday, June 29, 2011

Got into so much trouble this week Y'all

hey y'all,
got into so much trouble. In part because i'm so shy and quiet at times and i second guess myself a lot of times. And being so tired on top of it doesn't help either. I'm working on speaking up but not offending people.

So i get asked so many questions everyday and for the majority of the time, thankfully i manage to answer some of the questions right. But sometimes it requires a lot of thinking and reflecting or the preceptor has to stir me in the right direction. Some things are just not at the tip of my tongue.

So the other day, was so tired and sleep deprived and i got asked some basic doses and for the life of me, my brain was in sleep mode and just couldn't function. I drank coffee and anything i could to help but the tiredness would not go away. I was miserable and slow. And of course, people dont remember your good days, they remember your bad ones. So one preceptor basically labeled me as not knowing basic anesthesia stuff and not caring.

I mean i do care but that day i was so exhausted and slow. I swear, i couldn't move, i was in a twilite zone, and thats called sleep deprivation. Whatever, lesson learned, i'm sleeping earlier now.

See, there are advantages and disadvantage of front-loaded and intergrated programs. I met some students from the intergrated programs. And to be honest, they feel much more comfortable then i am in the OR now because they've been there since the beginning.
But, they've said how challenging it can be at times because they'll have a patient with a coexisting disease and they havent taken co exixting class yet and it can be difficult to intergrade coexisting disease into the anesthesia plan if they havent done it yet.

With me in the frontloaded program, i already know all that stuff but i have to constantly review because some of these classes i took in september and the material is just not on the tip of my tongue and i have go back and review. But, as far as clinicals i'm catching up to the intergrated people because i have clinicals 4 days a week and they have it 1 day a week. And what i learned today, i can practice again over the next three days. The intergrated people have to wait another 7 days to practice again what they have learned today and thats what frustrated them at the beginning. And when they come back, they tend to forget what they learned the week before. But there up to 2 days a week now but a shorter clinical day then i have.

So, in the end no program is perfect.

Sunday, June 26, 2011

The weeks of up and downs.

Hey y'all,
this past week wasn't one of my proudest weeks. yeah, your definitely going to have ups and downs, highs and lows but you just have to keep on tract with what your doing. And remember that there is a light at the end of the tunnel.

Definitely, talking to your classmates helps a lot too. And its comforting to know that you are not the only one having really great days and some bad ones too. This past week was pretty intense and having a really tough and mean preceptor doesn't really help your cause but.....what can you do? just do your best and put it everything you have. And again, I'm so glad that one of our professors brought up the topic of having 2nd toughs about doing this anesthesia thing. its a normal reaction because 1) your sell shocked the first week and everything just seems overwhelming and 2) you are transitioning into this new role. You dont have that crutch anymore of running to the resident it is your decision now.

So, its a normal reaction and i'm glad that i wasn't the only one feeling this way. And at the end of class, he just said to give it a couple of more semesters and if anyone of us is still having doubts then thats when action should be taken on our part. Honestly y'all, i love anesthesia and i already see myself settling into this new role and i should be fine.

Anyways, let me tell y'all about a few more cases i had. I still can't believe that i intubated a couple of kids already. I mean, i havent done my peds rotation yet and i'm now learning peds in the classroom. Anyhow, i was so nervous. First off, we did an inhalation induction that put the kid to sleep. I overpressured my sevoflurane to 8% and i have a mixture of oxygen and n2O 30/70%. I stuck the mask on the kid's face and that little guy was out like a light in a matter of 1 minute. The fact that the little guy was crying actually helped the induction go faster. Then after he was out, my preceptor started the IV while i stared ventilating the little guy all the while my eyes were glued to his vitals signs and watching his little chest rise. Then we induced him with a little propofol while i turned down my sevoflurane (avoiding overdosing here). I gave a couple of more breaths then i was reading to intubate. This little munchkin was like 3-4 years old.

Guys, as i reached for my laryngoscope and blade i literally felt my pulse shoot up and i swear i began sweating. I just took a nice deep breath, cranks his little head back, scissor his mouth open with my right hand. Inserted the blade with the left hand all the way to the right of the mouth. Swept the tongue to the left and lifted up and pointed my laryngoscope towards the clock anchored on the wall of the OR. And voila!!!!!! I had the best view ever so far!!!!!! i had a full grade one view!!!!I told my preceptor what i saw, kept my eyes on the cords. He handed me the ETT and i inserted the RAE ETT pass the cord, inflated the ballon, attached the ETT to my circuit, check for condensation in the tube, looked for ETCO2 on the monitor, listened for breath sounds and we were ready. I turned my ventilator on, double checked to see if my sevo was on, double checked the settings on the vent (i set the settings up before the patient came into the room) and then we positing him for surgery. off course we did a lot more after that before the time out, but surgery was smooth and emergence wasn't that bad. But when the kid came back to it, OH BOY!!!! he was not happy. He was out of control, he nearly sucker pushed me in the face!!! Man, those little guys are strong i was holding him down on the stretcher while someone else was pushing the stretcher. But overall, it was a great experience and i wouldn't mind doing more kids for anesthesia.

We did a couple of more kids after that but they were not wild on emergence like the first kid. But, you know what? peds anesthesia is not bad you know. I know i said i really liked regional anesthesia but peds anesthesia is definitely in the running as far as what i would like to do after this program is over.

Peds anesthesia.....we'll see
peace out y'all

Monday, June 20, 2011

Hey Y'all

hey y'all,
sorry for the late update. The first month of clinicals is really difficult, more difficult then i expected. I was just having trouble juggling things and fixing up my schedule to make time to blog. Its been a month now and i think that i've finally gotten a hang of it.

The first few weeks were really hard actually. The hardest part for me personally is just getting use to so many different personalities at clinicals. So far, i've had about 13 preceptors and each one thinks they are better then the next. And as soon as you've picked up a few tips from one preceptor, another one comes along and tells you that your doing things wrong and this is how you do it. Get the picture!!!

Anyways, i've learn not to focus on that aspect but instead pick up ideas here and there from each one and incorporate what i've learned from each into my practice. There are so many ways of doing anesthesia. And frankly, the hardest part if it all is emerging a patient from anesthesia. Wow!!!! Landing that plane after a smooth ride is not that easy. EVERYONE of the preceptor i've had so far does emergence differently.

Anyways, let me tell you about a few cases i've had so far.
lets see!!!hmmm

I had a brain aneurysm my 2nd week of clinicals. And you guys should have seen the looks on my classmates faces when i told them. Pure shock!!!!
i'm a novice after all. i've read what do in those situations but haven't put it into practice. lets just say that i was working like a dog. I had no idea what my assignment was going to be. We had just finished a case and my preceptor and i were walking and talking and mingling. Of course he was quizzing me about anesthesia stuff and all. His phone rings, he gives me this awful look and says " i know your new at this but we have to take this assignment, just do the best that you can, under normal circumstances you would never get this assignment on your 2nd week but we have no choice."
It wasnt too bad actually. In the beginning my preceptor and i were running around like crazy in the room setting up, gathering supplies for the worse case scenario. It was pretty intense the first hour and half. We actually went up to the unit to pick the patient. Brought he/she down and performed anesthesia. the patient survived and i learned a lot that day.

I had a number of laparoscopic robotic assisted surgeries. Those i find bizzar because the surgeon is literally sitting in the corner of the room controlling this robot. And frankly, the surgeon looks like a big kid playing a video game. He takes off his shoes and he literally looks like a big kid playing a video game. I mean, i know this is serious stuff. But men, this guy was having way way way too much fun for me at that corner.

I had a couple of bowel obstruction cases. Those were done with rapid sequence induction.

OOpps!!! look at the time.....i have clinicals in the morning.....i'll tell you guys more later.

peace out

Friday, May 27, 2011

And so clinicals/ residency starts.....

WOw!!!!what a first week!!!Absolutely amazing and i am learning so much. Dont get me wrong, its a lot to learn and a lot to remember from the didactic courses. But everything is starting to make a lot of sense and i am connecting the dots.

So far, the hardest part about clinicals is getting up in the morning. I am extremely exhausted but my body will eventually catch up. I'm just so use to staying up late till 3:00 am and waking up at 9 am to study. Going to bed early is certainty not fun but hey i have to do what i need to do.

Another issue Ive come across so far i having so many preceptors. it's only been 1 week and I've worked with 4 people. And each ones has their own ways and in between that there are also attendings that come in the rooms from time to time and they also want to teach you their own ways. And overall, this a lot to learn and with so many ways of doing one thing. whatever......

Anyways, getting use to the whole sequence on induction, maintenance and emergence of anesthesia. And don't forget, people are like quizzing you like crazy. The CRNAs that your working with are quizzing you and the attendings are also quizzing you as well. Anyways, you know quizzing puts you on the spot and can be nerve racking. But what can you do? you can only do your best and go home and review what you don't know and reread what you have forgotten. Of course, being the slick eyed monster that i am as soon as they ask me a question i'll ask them a question back as well and if they cant answer it, they'll leave you alone. Some people are really helpful quizzing and others just wanna make you look bad i feel. Whatever, i have thick skin and i can certainly handle the criticism with class cause i have a big ASS. LOL!!!

Anyways, school didn't start yet although clinicals did start. The trick now is trying the balance making these careplans every night for my patients and balancing putting in some study time for classes and for clinicals. I dont have any assignment reading for clinicals but doing care plans requires reading and i want to read over whatever i get wrong when my preceptor quizzes me.

I haven't intubated successfully yet. But its only the first week and right now I'm focusing on trying to learn the techniques of others then try them out for myself. Anyways, i haven't had any A-line or really sick patients yet. I've only had the typical hystorectomies, myomectomies, D&Cs, gastric banding, LMAs and ETTs.

Having fun guys!!!!
see y'all later

Sunday, May 22, 2011

I had orientation at the hospital

Lets just say that i didn't have a typical orientation and that the welcome to the anesthesia world was interesting.

So, this past week i went for orientation. I knew that it didn't involve any paper work because as i mentioned before this hospital is hardcore, these people just don't play.

Anyways, to start off the OR is HUG. Man, my preceptor had to basically force me to leave the OR and walk around. I was so afraid of getting lost. It was like 4-5 different hallways and countless room. Of course, my preceptors sent me to find some pressors. I was so lucky i didn't get lost, i swear. But i finally left the room after a couple of hours, wondered around the storage room and got myself familiarised with the setting. People were nice and actually this guy took time out to show me around the anesthesia work room and i'm pretty comfortable around there.

Anyways, our first case of the day went smoothly; the patient was successfully intubated, maintained and did well. And that's pretty much the better part of the day. After that, it went downhill. Pretty fast!!!!

So, our second patient, middle aged with hypertention, but not severe enough to warrant an Aline so my perceptor induced this person and i taught this was going to be a smooth course like the first case. Hey right!!!!

Anyways, this is orientation and I'm not allowed to do anything yet. I'm here to observe and they pounded that into me, YOU ARE HERE TO OBSERVE FOR TODAY DO NOT DO OR TOUCH ANYTHING. Ok fine!!!! you don't have to tell me that twice. Clinicals start next week anyways and my insurance didn't kick in yet. No worries.

Anyways like 15 minutes into the case (by the way, i cant go into details ya know HIPPA laws and stuff) while my preceptor was looking down charting, i (the big eye beast that i am) was looking around and BAM!!! the patient's BP was in the toilet and i have no idea why the alarm on the monitor didn't go off. You can not imagine what BP i saw. I swear i was frozen in terror for like 2 seconds (my first instinct was to reach for the phenylephrine or the ephedrine but I CANT TOUCH ANYTHING). So, i go to my preceptor (who by the way was lost in his/her charting and whatever else) and say look at your blood pressure. I swear, i never saw a human being move so fast in my life (the BP was really low guys-you have no idea).

Lets just say that after 50 mg of ephedrine, i don't know how many mcg of phenylephrine, 80 units of vasopressin later the BP was in the toilet. Of course we had to call for backup, the situation was getting out of hand.

Anyways, basically this patient had an allergic reaction. Of course, we don't know which drug because we pushed like 5 meds back to back during induction and on top of that the surgeon injected some locals. So, he/she ended up stabilizing the patient and putting an A line.

Then my preceptor turns to me, smiles and says "so what do you think?". I simply smiled.

what do you guys think of my orientation?

Anyways, clinicals start next week and for some reason I'm not at all nervous. People keep saying they are so nervous. I didn't want to look cocky or overly confident in front of my classmates so i said i was nervous too, but really I've been reading a lot these past few days and i don't think I'm at all a rock-star but I'm just not that nervous anymore. I just wanna get this show on the road.

Anyhow, I'm enjoying my last weekend before clinicals.

Wish me luck guys!!!!

Friday, May 20, 2011

grades are in !!!!!

Grades are in and I'm pretty excited!!!!!All the hard work paid off and i am counting down to the first day of clinicals. This is one of many miles stones completed in this program.

So, 3 semesters down and 4 semesters to go. While clinicals start soon, i still have a heavy class load. With clinicals and class time eating away at 5 days a week, I'm only left with the weekend to study. I still have some more core anesthesia classes to take. I am no where near feeling 100% competent yet but I am definitely on my way.

I know that the first rotation, the preceptors don't have high expectations from you. They expect you to know basic anesthesia knowledge but don't expect you to successfully intubate every time around.

My first few rotations are general rotations and i start specialty rotations around april 2012. my classmates are so nervous about their peds rotation, but I'm actually looking forward to it. It should be fun fun fun!!!!

I got my mass general pocket guide, the hard to find Ezikiel pocket guide, i got my Ipad2 with lots of anesthesia apps, my nurse anesthesia pocket guide and i am ready to go.

I am so thankful that ive made it this far. Remember a while back, towards the beginning of my blog i spoke about my friend who failed out of the program. She got dismissed after the didactics portion. This is certainly not a reflections of her intelligence and i will say that this last semester was really hard and i can understand where she fell thru the cracks.

Now with clinicals its adjusting to another type of stress; waking up early, setting up the rooms before your preceptors come, answering questions on the spot, getting yelled at by your preceptors, doing actual procedures on my patients. No more mannequins. Well, maybe once in a while I'll sneak into the lab to play with the mannequins, we'll see.