Monday, September 29, 2014
Monday, September 08, 2014
powerless to resist
Like a starlet chases fame
And the addict snorts cocaine,
We are powerless to resist
The attraction to the flame.
Powerless to resist inherent DNA
Or the tide; the moon obey.
We are powerless to resist
When Our id is brought to play.
To a false moon even, we rise.
the illumination fools our eyes.
We are powerless to resist
That which culminates in our own demise.
Sunday, July 20, 2014
Frank's place (Magpie #229)
Frank's Place was a grocery store,
just up the hill from the river's shore.
Where he, the Frenchman, and Irish wife
raised their brood, lived their life--
Then the Lord, who's word they followed,
brought them home to the place most hallowed.
Of the eleven children they conceived,
Five, alone, were left bereaved.
All their children have joined them there;
At Frank's Place, the French cimetière.
Sunday, July 13, 2014
Passing the baton
Back story: On the 8th of June we were in Texas at our son's house for a BBQ celebrating his oldest daughter and our grand daughter's high school graduation. As is common with family get togethers, we were all gathered in the kitchen chatting about a multitude of topics. I was sitting next to the graduate's sister, Crystal Lily (pictured at left) who engaged me in a conversation about her goals for the future. Mind you, she is about to enter the ninth grade.
Crystal: "I want to be a surgeon."
G-Pa: (that's her current nickname for me. Her whole life long she has been famous for her Crytalizims.) " What kind of surgeon do you want to be?"
Crystal: "Either a brain surgeon or a cardio-thoracic surgeon."
G-Pa: "wow, that's pretty ambitious. What makes you think that that's what you'd like to do?"
Crystal: " I like to see and touch things and find out how they work."
A discussion ensued that was essentially an anatomy and physiology mini-course, with Crystal asking pertinent questions one would expect from someone much older. I expected as much because of her astute observations and discussions we've had at our camp on the St. Lawrence River over the past 10 years. She travels here, to New York, from Texas every year to spend 3 - 4 weeks with us. I've watched her develop a pascal of talents; a good vocalist, budding guitarist, a talented artist, an accomplished competitive swimmer, world traveler, and not the least; an interesting conversationalist with all age groups. All of this in a thirteen year old.
Crystal: "G-Pa, could I go with you to the operating room when I come to camp this summer?"
G-Pa: " Let me check with the permission granters at the hospital, and if it's OK with them, I'd love to take you to work with me."
For a one day visit, it was determined that all she'd need would be a TB tine skin test. She was OK with that and her mother gave permission for us to get her tested when she came north.
On Friday, 11 July with TB test results in hand, we went to the outpatient surgery site where we were to do 18 cataract surgeries divided up between two rooms and one other CRNA (registered anesthetist.)
I've mentored many students from my position at the head of the OR bed in my 40+ year career. However none as young as Crystal. She displayed an attentiveness to the tasks being performed, be they anesthesia, surgery or nursing, as well as any student I've seen and more so than some much older. She asked pertinent questions and was forthcoming with salient answers to questions from everyone. The staff treated her with respect and a willingness to teach her, and were surprised to find out that she was "only" thirteen, thinking her to be at least 16.. It was a full day of surgery lasting a little more than than 8 hours and she never sat down with the exception of our lunch break. She did express that her feet were sore at the end of the day from standing so much.
Crystal: "Do cardio-thoracic surgeons have to stand that long when they operate?"
G-Pa: " yes they do and some brain surgeries take longer than 8 hours!"
I made two faux pas this day, one was failing to introduce Crystal to the surgeon first thing; he had to ask during the surgery who the observer was. Poor form on my part for which I apologize. I did introduce her to each patient and ask their permission for Crystal to observe.
From that point on, Dr. Ishman took time to engage Crystal in a give and take about her goals and what choices she was making, offering advice and tips to make the road a little easier. One such tip was that if she did decide to pursue the path to become a cardio-thoracic surgeon, that she postpone geting married until she was finished with her training. He took time to explain to her each step in the process of cataract removal and insertion of the replacement lens, making sure the extra microscope was positioned so she could see closely what he was explaining.
Number two faux pas was forgetting to take a picture of her in her surgical garb. I was too taken up with the seriousness of the tasks at hand, ( trying to set a proper example for my grand daughter) and she sensing as much was reticent to ask even though it crossed her mind. We actually put Face Book on the back burner for that time.
Crystal expressed a complete satisfaction with her experience both surgical and otherwise. Otherwise being intimate girly talk with Anne and Christine, thinking it humorous when they asked her how old she was and the shocked looks on their faces. They declared her to be only a baby; Chris noting that her son was Crystal's age.
On the way home: Crystal: "Can I go with you to the OR again next year?"
G-Pa: "If you're still interested, yes."
Last night we text-ed my friend Leigh, an OB/GYN surgeon and asked if he'd like to take Crystal to work with him this week. They share a birth date to which Crystal has always laid claim to as hers, but said to tell Leigh that she'd give the date back to him if he'd take her to work with him.
Wednesday, May 28, 2014
Making a difference
What do you call a socially inept, insecure, weak, timid, athletically disinclined individual? Dork, nerd (as in socially inept,) geek, dweeb? Perhaps any or all apply at various times. What ever, I admit that that was me from 0 to 8. Not that a complete transformation occurred on my eighth birthday. By no means, but the road to change was embarked on and I have quite a few people to thank for that.
Tuesday, May 27, 2014
Notes from The Head of the Bed
Notes from the head of the bed
Let’s start at the beginning. Well my beginning; as I used to say to my kids; “nothing happened in your world “til you were born.” “Anything before that is called history and is subject to interpretation.
In the beginning you dream, are inspired, have a proclivity for, or maybe had/have a relative whose career was in the health care field. After some suitable investigation (suitable for you) you decide you’d like to administer anesthesia for surgery.
Choices; it’s always about choices isn’t it? What career path will lead you “the head-of-the-bed” where you will be able to provide anesthesia? Today, 2014, there are three avenues to THoTB: become a physician who specializes in anesthesia (MDA), become a registered nurse who specializes in anesthesia (CRNA), or become an anesthesiologist assistant (AA). What’s the difference, you ask? That’s the age old question that patients frequently ask their anesthesia provider. The simple and time effective answer, (remember, in the OR, time is of profound importance,) is; an anesthesiologist is an MD, a nurse anesthetist (a-nez-the-tist) is a registered nurse (CRNA,) and an anesthesiologist assistant is person trained specifically to assist anesthesiologists and under their direct supervision.
This may seem more complicated that it really is. Remember these two caveats when things appear complicated; it’s always about the money, and “Plus ça change, plus c'est la même chose,” (the more things change, the more they stay the same.)
Now back to the beginning, mine; the short version. In 1969, when I made the choice to go to “anesthesia school,” the requirements were: 1. you must be a registered nurse, (RN.) 2. You must have had at least one year as an operating room nurse. The course was 18 months, and after successfully completing your program you were required to sit for a national exam and if you passed you were allowed to use the title CRNA, (Certified Registered Nurse Anesthetist.) There was no (zero) tuition, but you did have to give a deposit of $350.00 which would be returned at graduation if you didn’t break or lose any equipment. At that time a CRNA could expect to earn twice what an OR nurse was making. When I left the OR for anesthesia school I was earning $7,500.00 per year with call pay included. Five years later I started in the same OR at $17,000.00, call included. Pretty good return on investment, don’t you agree?
Just so you know, back then there were few “anesthesiologists” per se. Most MD heads of anesthesia departments, in my neck of the woods, were GPs (general practioners) who’d received some on the job training in the military during WWII. They in-turn trained some of the OR nurses in their departments to do anesthesia and they were referred to colloquially as “Chin Holders.”
Fast forward to today. If you choose to apply to a course of study leading to a title of CRNA, you must meet these requirements: (these requirements will change by 2016) 1. You must have a bachelor’s degree in nursing (BSN,) 2. Have at least two years experience in a critical care clinical setting. If you are accepted, you course of study will be 30 to 36 months in length. Most programs are now university based rather than hospital based and will cost you no less than $150,000.00 to $200,000.00 for the 3 years of study. You will graduate with a Master’s degree in nurse anesthesia, (soon to be PHD.) After successful completion of your program you will also have to take a national certifying exam.
Your investment to attain CRNA status today;
4 year BSN program @ ? $40,000.00
2 years as critical care nurse.
3 year MSN anesthesia program @ $200,000.00