She's As Cold As Ice*

When I first told the world I wanted to become a CRNA, I remember one ICU nurse in particular discouraging me stating that the OR was too cold of an environment for someone like me.

I'm not sure what he meant by that. Especially, the someone "like me" part.

So here is the solution I came up with in my head (please keep in mind my math stills are rusty and include lots of creative rounding**):

How to deal with cold OR environments
1. Increase your ambient temperature. This is a good idea also if you are in situations that include trauma, coagulopathies not related to trauma, coagulopathies related to trauma, pediatrics, burns, pediatric burns, and pediatric coagulopathies. (Author's note-never let anyone find out that it was you who increased the ambient temperature...the OR really is a "cold" place and they'll yell at you)
2. Under Armor. I am quite a fan of this stuff. Not only because it looks stylish, but because it has the ability to seal heat in and in the event of being stuck in the trauma OR, it wicks away sweat so you always look like you are maintaining your cool (while throwing up inside your mask because you're secretly terrified)
3. Steal the Bair Hugger from your patient. Once their core temperature has been successfully stabilized over 36.5 degrees, I feel it is fair to play the game of "one for you, one for me." That is, one minute (or so) of warm air blowing on you, one for me.
4. Huddle next to the lamp on the anesthesia machine. Beware, because if you are wearing gloves, they may melt and burn you....not that I would like know about that or anything***.
5. This is my favorite. The way to overcome the coolness in the OR-be nice and caring to your patients. Yes, the OR is an impersonal, cold, and sterile**** environment. That is why I take the skills I learned as a nurse and show each and every patient the compassion and empathy they deserve. I was recently approached (er...accosted) at FedEx by the worker who noticed that I was mailing anesthesia related paperwork. One thing lead to another and he ended up asking me if it was okay to use illegal drugs and undergo anesthesia. Let me tell you (NO-it isn't!! DUH!), I don't really care why he asked me and no, I don't care if you do drugs at home. I don't care what you do at home. I care that you are honest with me so I can appropriately take care of you.

Let me hop on my pro-CRNA soap box yet again. One reason why I love been a CRNA (*student*) is that I am able to take the caring and compassion I learned as an ICU RN and translate it into caring for someone during the scariest times of their life-surgery. I literally hold some one's life in my hands everyday. My career choice was reaffirmed the other day. I was working in GI doing colonoscopies when I was called to do a larger procedure that required the patient to be intubated. The patient looked at me (no clue who she was), and said-Oh thank god it is you. Do whatever you did last time because I felt great afterwards. Even though I didn't remember her, obviously she remembered the care (and extra Zofran) I gave her. It made my day and hers too.

*Allegedly
**No worries, my math skills in the OR are really quite good. Plus, I can whip out a calculator so fast it'd make your head spin.
***Seriously, you'll only be allowed this technique once. Ouch.
****I actually don't believe in sterility. Unless you are talking vasectomy. I like to think of it as really clean instead.

I don't always HAVE to win*

*I'm just a more pleasant person when I do!

No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians
Brian Dulisse1 and Jerry Cromwell2,*
1 Brian Dulisse is a health economist at the Research Triangle Institute, in Waltham, Massachusetts.2 Jerry Cromwell (jcromwell@rti.org) is a senior fellow in health economics at the Research Triangle Institute.
In 2001 the Centers for Medicare and Medicaid Services (CMS) allowed states to opt out of the requirement for reimbursement that a surgeon or anesthesiologist oversee the provision of anesthesia by certified registered nurse anesthetists. By 2005, fourteen states had exercised this option. An analysis of Medicare data for 1999–2005 finds no evidence that opting out of the oversight requirement resulted in increased inpatient deaths or complications. Based on our findings, we recommend that CMS allow certified registered nurse anesthetists in every state to work without the supervision of a surgeon or anesthesiologist.


Full article:
http://content.healthaffairs.org/cgi/content/full/29/8/1469?ijkey=ezh7UYKLtCyLY&keytype=ref&siteid=healthaff

The Quarter Life Grown Up

I had this conversation with a good friend a few months ago, for some reason, I do not feel like a grown up.

*Now, lets just start off on the right foot with a first amendment disclaimer-I can only speak for my life and my situations. I DO realize how fortunate I am in this life, I'm just sharing a story.*

Back to me (second child syndrome, I don't like having the attention taken away!), I just have never felt capable of grown up decisions. Sure, I bought a house, got married, got into graduate school, and choose which life saving drugs to administer on a minute by minute basis, -but does that make me a grown up? Sometimes, while driving in my car, I get strange pangs of anxiety like I should have asked permission before running to Target for toilet paper. (What would my mom think?)

Recently, I hit the quarter life mark. 25 is such a nice number, but I haven't quite figured out how it fits into my life yet. Quarter life seems so grown up, but still riddled with teen angst (exactly my situation). And worse, if you asked me my age, I'd reply 23 without hesitating. Not because I want to shun the quarter, but rather because I honestly feel mentally blocked at 23**. Or did.

Now that I have lived on my own for the very first time in my whole life, I reluctantly entered adulthood as reluctantly I cross the state line to Florida (sunshine state my ass*). While I moved to Albuquerque when I was 18, I was never "technically" alone. I always had someone and somewhere to fall back on. Even for the few months I lived in a ghetto apartment by myself (a stupid, rash act of defiance and proving I was an "adult"-ha!) but I could almost always be found at a friend's dorm room instead. I'm still figuring out what this adult stuff means. I just hope becoming an adult doesn't mean I have to start wearing high waisted jeans and quit cursing. Because then, I just don't think it'd be worth it.

*Dear State of Florida, I'm sure you are a very nice state. It sure is green here. However, I just wish we met under better circumstanes. That, and I've noticed it sure does rain every day I want to go to the beach. Have you been to Arizona? It NEVER rains there, the sun is ALWAYS shining in the Grand Canyon state. And that Land of Enchantment? Enchanting...also, boasts quite a few days of sunshine...hmmm....
**Not really sure what happened to 24. It might have been like how my maturity level when from an 18 year old to a 30 year old? Was I ever 21? Nope, just 18 :(