Absence Makes the Heart Grow . . . Fonder?

Well it has been over a month since I last posted anything and I have been chastised from several sources so I am attempting to rectify my slothfulness. Since last I posted I have made the transition to yet another clinical site but this time I am able to live at home while working there. The new location is called American Fork Hospital and it is only about 8 miles from home. It is considerably larger and busier that either Soda Springs or Montpelier. In the two months that I was in Idaho I participated in 63 cases. In my first two weeks in American Fork I did 67. Needless to say I am having to pick up my game a bit. I feel quite overwhelmed but I am grateful for this chance to work on speed and to really hone my anesthesia skills.

How Great Thou Art

I spent the weekend in Logan with my brother and his family and was driving through Logan Canyon at about 10pm. It was a moonless night and the canyon was extremely dark. It was difficult to see even with my high beams on. After my near miss with the deer in Soda Springs I was moving very cautiously. The trees and rocks cast eerie shadows and made me feel uneasy. I felt foolish for being scared but the darkness was so palpable that it made everything seem ominous. I began to feel depressed about the fact that it was to be another week before I would get to see my wife and kids. I started to feel overwhelmed with my chosen career, feeling like understanding anesthesia was just too difficult and beyond my capacity. After a while I recognized that I had allowed the darkness of the night to give place in my heart for another power of darkness and I was allowing that power to take control. I found a safe place to pull of the road and I turned off my car and got out. I looked up to heaven and cried to God for relief from the burden of the darkness in my heart. My eyes then took notice for the first time of the night sky. It seemed that the heavens were aflame with celestial white light. The expanse of space before me was filled with innumerable points of light. The thick carpet of the Milky Way had never been clearer to my naked eyes. The darkness within me melted away and gave place to a burning gratitude for the Creator. Those trillions of stars and planets and galaxies, rather than making me feel small and insignificant, made me realize how incredibly real God is and how much he loves his children. I was filled with light and a sense of my own worth. I felt a renewed vigor for life and all the challenges it holds to us in this our mortal probation. After a few minutes I got back in my car. As I finished my drive to Montpelier I thanked God for the darkness of the night that allowed me to see and to feel of his goodness.

So Long Soda Springs

I drove to Soda Springs this morning for the last time. Today marks exactly one month since I started my clinical training as a nurse anesthetist. I have loved my experience in Soda Springs. The hospital and staff could not have been nicer and more accommodating. It was not because of them that I arrived each morning feeling like I was going to vomit but because of the fear of doing something wrong. In large measure the fear has left me and a cautious sense of understanding has started to replace it. Anesthesia is fascinating and a lot of fun.
This picture is of a reservoir that you can see from the hospital parking lot. I took it this morning as the sun was coming up and reflecting off of the water. I will miss the drive up to the hospital through the farm land. However I will not miss the near misses of all the deer that seem to congregate on the highway just before the sun comes up. I actually bumped into a little fawn the other day. Basically it hopped out of the way just in time and my bumper lifted it a little higher.
This picture is of some of the operating room staff I have been working with. From left to right you will see Flora the OR manager, Josh the CRNA that has been training me, Kasey, one of the scrub techs, and Patty, one of the OR nurses. I so appreciate their patience and help as I muddled my way through my first month. On to Montpelier.

Fat City

There really isn't anything too exciting to report and so I have decided to write about my goal for October. The picture to the left is one that was taken in the spring of 2001 when Cami and I had completed a 12 week Body for Life Challenge contest and submitted our before and after pictures. I had never undertaken a health challenge prior to that time and anyone that has seen me lately can attest that I have not done so lately either. Like many of you I have found that it is easier to eat what is convenient and tastes good rather than that which is beneficial. I have found that I was feeling run down and tired all of the time. My endurance was non-existent and there was just no more squeezing into the old 34 waist jeans anymore. Back sometime in June I got an app on my itouch called LoseIt that allowed me to track my calories and log exercise. You enter in your height and weight and then enter a goal. The program calculates a daily calorie allowance that if followed should result in weight loss. I was excited at the novelty of the app initially but as usual grew bored with it and only entered anything periodically.
Cami and I were on a trip in the car sometime later and I was helping myself to some red licorice that is a staple for any of our long distance journeys. I began to feel sick from eating so much but in true Rush fashion persevered until I had truly made myself ill. The seat belt was tight around my ever-expanding waist line and I noticed how a large panus now flopped over the belt and jiggled with every bump in the road. I was disgusted with myself. I was tired of having no self

control. I made the same resolve that I had made a hundred times, to control myself by eating right and exercising regularly. I started mountain biking with my brothers and was astounded at how little I could do initially and then at how fast my body seemed to remember how. I began to eat more consciously, entering in the food into LoseIt. I began to be aware of how expensive calorie wise some foods were. I started logging activity and compared the difficulty of eating a lot of calories with burning a lot. I still did not eat like I knew I should but I ate more deliberately, when I was hungry rather than when I felt like it. Slowly my chins started to evaporate. I started to feel more energetic. I noticed that I slept better and woke up feeling rested and had less heartburn. I went from 214 lbs down to 189 within a couple of months. I have been hanging around bouncing between 185 and 195 for the last couple of weeks. I have a desire to make some more permanent changes in my attitude and actions and wanted to post it here to have some accountability for my commitments. I have decided to begin a Body for Life type diet balancing carbs and protein while staying within my calorie allowance (1780 calories a day) having a free day on Sunday in which I can eat what I want. For exercise I am going to start the cursed P90X routine. I have been doing it for a couple of weeks and I like how it includes more than just muscle building but also flexibility and range of motion activities. So I will be doing 90 days of this starting October 1st. I will report my progress with appropriate pictures (this is a family blog after all) periodically. It will also give me something to write about when topics are a little sparse. Please feel free to give advice or join in with a program of your own

Talk The Talk

I figure it is about time to talk a little about anesthesia and what exactly I do. Anesthesia is the science of pain control for patients undergoing painful procedures. Besides controlling pain response an anesthesia provider also provides, amnesia and analgesia which involves paralysis and inhibiting recall of the events. This is accomplished through a combination of drugs that can be delivered by injection into the muscle, blood stream or the lungs, some are even absorbed through the skin. This is a picture of the anesthesia machine and monitors that I use at the hospital in Soda Springs. This machine has a ventilator on it that can breath for the patient and delivers the gas that helps to maintain an anesthetized state.

This is the medication cart that I use that holds most of the commonly used drugs. Some of these drugs are used to paralyze the patient so that they do not move during surgery. These drugs are based off of a naturally occurring substance called "curare" that the Amazon natives would put on the tips of their arrows to paralyze their prey.

The last two pictures are to show the get-up that you have to wear in the operating room. This traditionally is made up of a goofy hat to make sure your hair stays on your head, a mask (not made to fit those of us with "fuller facial features" very comfortably), and awesome shoe covers.

Fall Colors

I was driving through Logan Canyon yesterday as I headed back up to Montpelier for the week and nearly wrecked my car for staring at the colors in the canyon. Absolutely breathtaking. I finally pulled over at a place called Tony Grove and took some pictures. The pictures, I am sure, will not do the scene justice but at least you will be able to appreciate the sight a little bit.

I love this time of year. The chill in the air and crisp clean mornings. It is especially cool to be in a farming community because the wheat is being harvested and the sweet smell of freshly cut grain is everywhere.

The Beauty of Idaho

After I got home from the hospital yesterday I decided to go on a rather long but easy bike ride. I saddled up my trusty old mountain bike and packed some water and snacks and headed to the Bear Lake Wildlife Reserve. It was a beautiful afternoon and the scenery was spectacular. I rode a total of 16 miles and by the end started to feel it. The terrain was relatively flat but it was a rough dirt road for about ten miles of the trip. I love the old farmhouses and barns that dot the landscape here. I took my camera along for the ride so I will include some of the pictures I took.

Second Week

Hello there one and all. I have survived to write another entry. I went home for the first time last weekend and it was glorious to be home. I must say I am not looking forward to Texas where home is all but inaccessible. I will also be heading home this weekend to help my brother pour some concrete. So while expensive on the fuel end it will be good to be home. My roommate has finished with his cases for the week and has headed home already. Luckily I have cases planned through Friday. So far this week I have done my first labor epidural that could not have gone smoother and my first MAC cases which means that you just heavily sedate the person rather than putting them completely under, like for a colonoscopy. I am absolutely loving every second I am doing anesthesia. My uncle is an anesthesiologist and told me long before I went to nurse practitioner school that I should be a nurse anesthetist but I did not listen, until now. Oh well, live and learn. I certainly do not regret the marvelous experiences that I have had as a NP.
My kids have asked where I live and what I do there so I have photo documented my little apartment so that they could see where dad sleeps and does his homework. The set up is actually extremely awesome. Awesomeness #1 is that it is free. Awesomeness #2 is that we get to eat at the cafeteria in the hospital for free. Under normal circumstances you may not see this as a blessing but the hospital here is small enough that they make all their food daily from scratch. MmmmMmmm Tasty. Awesomeness #3 they have all you can drink soda fountains with a large variety of not so good for you drinks. Truthfully I am extremely grateful to the hospital in Montpelier for providing us with such incredible accommodations. So without further adieu . . .

This is the front of our building. The door on the far left is the door to the Bear Lake Health Department. The door on the far right is an optometrist's office. The door in the middle is obviously the door to our basement apartment. Opening the door leads to a very steep flight of stairs that takes you to our door under the optometrist's office.

If you open our front door this is what you would see. This is my room. Since I am the Soda Springs guy I get the front room and the cot. The Montpelier guy gets the nice bed as you will see in the next image.

This is the larger of the two rooms. The Montpelier guy usually gets this side. There is a lazy boy and TV also in this room.

This is our kitchen. It comes fully stocked with dishes and all the cooking stuff you would need if you actually cooked something. There is a dining room table and a couple of chairs.

This is our bathroom. Enough said.

Well, that is the grand tour. So if you are ever in the area you can pop in and say hi.

My First Week

The Nurse Anesthesia Program at Westminster College is front loaded meaning that most of the course work is done up front and then clinical rotations begin. Due to the domination of a single anesthesia group (that does not like nurse anesthetists) in most of the large facilities in Utah clinical rotations in the state are few and far between. We have to go out of state to get experience with big cases in trauma centers. Almost everyone in our program will spend some time in El Paso, Texas for that reason. My clinical schedule as of now looks like this:
September--Soda Springs, ID
October--Montpelier, ID
November-December--American Fork, UT
January-April--El Paso, TX
May-July--American Fork, UT
Aug-Nov--Evanston, WY

So last Monday I packed up my stuff and drove to Logan to stay with my brother. The next morning I headed to Caribou Memorial Hospital in Soda Springs, Idaho for my first day of clinicals. The hospital has one operating room and is staffed by one nurse anesthetist 24/7. The hospital services a population of about 8000 and they do about 40 procedures a month. The slower pace makes it an ideal location to get your feet wet without having to drowned on your first day . . . or so I thought. I arrived about 8 in the morning knowing that there were three cases for the day all of which were to be laproscopic procedures. I figured I would watch the first case maybe try my hand at intubating the second patient and if I felt really daring manage the vent on the third. My clinical preceptor evidently had a different idea. I walked into the operating room got dressed into my scrubs and was then told that the patient was mine and to pull up the drugs in the right doses that I wanted to use. I was terrified. Sure I had done this a thousand times during our summer courses but that was pretend, drugs were given to a plastic manikin not a living, breathing, talking person. I shakily drew up my medications telling my preceptor exactly what I was doing and double checking my doses. I prepared my tubes for intubating and checked the light on my laryngascope and arranged everything neatly for my preceptor to use. The patient was brought
to the operating room and placed on our table. I looked expectantly at my preceptor and he said, "so what are you going to do now?" I seemed to immediately forget everything I had studied over the previous year and felt like I was in a weird dream where everything including my thoughts moved at a turtle's pace. I managed to hook up all the monitors and administer some of the medications I knew that we needed prior to intubating. I hesitated at giving the paralytic knowing that once that was given I had to be able to control the patient's breathing or we were all in trouble. I held my breath and said a silent prayer and pushed the medication into the IV. In about 30 seconds the patient was asleep and immobile and I needed to place the endotracheal tube so that I could hook them up to the ventilator. I struggled to position the patient's head so that I could insert the blade of the laryngascope. Everything felt awkward and nothing like what I had practiced in the safe controlled environment of the lab back at school. My preceptor came to the rescue and inserted the tube for me and then had me manage the rest of the case. With my first case under my belt I felt like perhaps I really could do this. I started to develop a routine for what to do and in what sequence to do it and by the third case felt much more confident. I had successfully intubated the last two patients and overall it was an incredible experience.
We finished for the day at about 3pm and I headed to Montpelier where we would be staying. By we, I mean the other student in my program (Michael) that was going to be at Bear Lake Memorial Hospital in Montpelier and myself. The hospital in Montpelier gets medical residents and they have an apartment that they let them use. When no residents are training at the hospital it can be used by anyone else. I arrived before Michael and unpacked all of my belongings and it finally hit me that I was living somewhere other than with my family. My heart was heavy and I had a hard time feeling excited about the prospect of being there for two months. I called Cami who sensed my depressed mood and as is her norm buoyed up my spirits and filled me with hope and enthusiasm for what lay ahead. Michael arrived and things started to look up as we joked around and swapped stories of our clinical adventures. Throughout the week I would do another abdominal case an epidural and a spinal. In my first week in the trenches I was able to be exposed to nearly all of the different types of anesthesia that we as nurse anesthetists do. I can't by any stretch say that I am comfortable with my abilities but there is something to be said for being able to say that you "have been there and done that." I am looking forward to the opportunities available to me in Soda Springs and think that I will enjoy the experience immensely.

In the beginning . . .

Before I start get into what is going on currently some may be interested to know why I chose to go back to school in the first place. This story begins about two years ago when I was in the car with my brother Greg. We had just finished playing raquetball and were discussing our future career plans. Greg asked if I saw myself doing what I was doing for the rest of my life. I considered his question. I was happy with what I was doing. At the time I was working with a vascular surgeon as a nurse practitioner. I felt like I was contributing to society and using my talents to make people's lives better. However, as I contemplated over the ensuing days the prospect of never doing anything different I began to feel a desire to make a change.
Why nurse anesthesia you may ask? Well the truth of the matter is that I considered nurse anesthesia while I was still attending my nurse practitioner program at the University of Utah. I found a program that would bridge me into a nurse anesthesia program so that at the end I would graduate with both degrees. I applied and was accepted but before making the change I got cold feet and decided to stick with my chosen course and see how it played out. I graduated with a degree as a Family Nurse Practitioner in 2006 and started working in a family practice office. Initially I enjoyed the challenges of family practice but quickly grew tired of seeing 40 people a day having 5-7 minutes per patient and constantly being double or triple booked. One night I met with a distraught young lady about my own age that had just had a baby and was struggling with severe postpartum depression. She reported that she had considered suicide and was coming to see me out of desperation. I had three other rooms with people waiting for me already upset because I was running behind. I did my best to help this young lady in the allotted time I was given and then was forced to move on to my other patients. Upon returning home I began to look for another position. Over the next four years I worked with an interventional radiology group and for the vascular surgeon who was also part of the group. I found that I was happier there being able spend a bit more time with people. The longer I worked the more about myself I began to learn. I liked being more specialized rather than doing family practice. I found that I did a better job when I knew more about the underlying problems the patient's were facing. I liked to be able to feel like I really knew what I was doing. When I decided to go back to school I knew that I wanted to do something that I could truly master, something I could make my own, and anesthesia fit the bill.

Mission Statement

My intention in writing this blog is primarily to keep my family and friends up to date on how things are going in the world of nurse anesthesia. A secondary purpose is to provide individuals who may be interested in pursuing a career as a nurse anesthetist or in pursuing an Air Force scholarship through the HPSP (Health Professional Scholarship Program) with the inside scoop based on my experience. That being said I feel it may be necessary to say that my opinions and experiences do not necessarily reflect your experience or opinion. I am not a spokesperson for the Air Force or the AANA (American Association of Nurse Anesthetists). I would refer you to both websites for more information directly from the source.

Now that the disclaimer is out of the way let me introduce myself. My name is Brett. I am a 33 year old father of three. I have been married to my beautiful wife for going on 13 fabulous years. I live in Utah, and yes, I am a Mormon. I am in my junior year at Westminster College. I started the 27 month Master’s of Nurse Anesthesia Program in August of 2009. I was commissioned as a 2^nd Lieutenant in the United States Air Force in March 2010 and received the HPSP scholarship at that point. My wife and I had discussed all of our options for paying for school and had settled on going the route of student loans. Now like most of the Christians in the world I have a fervent testimony of prayer. Upon making the decision to pay for school with loans we took our plan to the Lord and felt OK about it. There was no heavenly manifestation or burning bush but just a feeling that it would be alright. However, knowing that what I think is not always what would be best I suggested to my wife that we pray about joining the Air Force. And so we did. The answer was completely different, there was absolutely no doubt that the best thing for me and my family would be to join the Air Force. The funny thing about prayers is that once you get an answer it is hard to go back to what you wanted to begin with, especially when there was such a distinct and palpable difference in the answers. So, obviously we took a leap of faith and accepted a commission with the USAF. The great thing about the scholarship is that it pays for all of your tuition (from the time you are commissioned, not retroactive to the beginning of the program as a recruiter may tell you) and they pay you a living stipend of $2000 a month. I do not have any commitment to the Air Force until I pass my boards and am a fully qualified CRNA (Certified Registered Nurse Anesthetist). Then I will attend Commissioned Officers Training for five weeks in Alabama. I will then be recommissioned into the Nurse Corp as a Captain (because of how many civilian years of experience I have, 2 years civilian exp. counts as 1 military year of exp.). Then I go directly to my first duty station. I was asked to pick my top 5 base choices for my first duty station which were: Langley, Virginia; San Antonio, TX; Dayton, Ohio; Colorado Springs, CO; and Eglin, FL. I owe the Air Force three years of active duty service and 5 years of inactive reserve after which we will be done, unless of course we decide to make a career of it.