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.