The happiest people on earth all have their fair share of low moods, problems disappointments, and heartaches.

National CRNA Week

January 24th through January 30th, 2010

Today begins a week long recognition of Nurse Anesthetists. This is the 11th annual such recognition. It's a way to make the general public aware that when ever they have surgery, the person at the head of the bed administering their anesthetic is just as likely to be a nurse anesthetist as it is an M.D. anesthesiologist.

Does that mean that nurses have only been administering anesthetics for eleven years? No. No it doesn't. It means that 11 years ago some individual or group of individuals decide that a public relations effort needed to be instituted to make the public aware that not every deliverer of anesthesia was an anesthesiologist. Nurse anesthetists (CRNAs), in fact, were one of the first Advance Practice Nurses in healthcare. Even that term, APRN (advanced practice nurse) only came to the vernacular in 1965. (the first Nurse Practitioner program was created by a nurse educator, Loretta C. Ford, Ed.D., R.N., P.N.P. and a physician, Henry K. Silver, M.D., in 1965 at the University of Colorado as a non-degree, certificate program training Registered Nurses for advanced roles as Pediatric Nurse Practitioners due to a shortage of primary care physicians.)

Nurse Anesthesia practitioners on the other hand have been administering anesthesia for some 150 years. To digress here for a moment; in researching my genealogy I discovered that one of my great grandfathers (Daniel Story) was a musician/soldier in the Civil War. I further discovered that these musicians also served as the care givers, medics if you will, to the wounded soldiers during Civil War battles, and as such delivered the anesthetics when the physicians did surgery. Musicians, as medical assistants:The non-musical duties of bandsmen were primarily medical. Before battles, bandsmen gathered wood for splints and helped set up field hospitals. During and after the fighting, they carried the wounded to hospitals, helped surgeons perform amputations, and discarded limbs.

I've been a CRNA since 1972 and over the course of that time the two most frequent questions asked of me pertaining to my profession have been:

1. What is a nurse anesthetist? And,

2. What's the difference between a nurse anesthetist and an anesthesiologist?

I'll spare you the quips and jokes that have grown legendary in response to these questions and I'll also spare you the political attestations that abound as to those differences. The simplest and most obvious answers are; a nurse anesthetist is a Registered Nurse who administers anesthetics and an Anesthesiologist is a doctor who administers anesthetics. In a setting, operating room or otherwise, where anesthesia is being given to a patient for any procedure, the person administering the anesthetic, whether doctor or nurse, together or alone, is doing the same thing, have been trained in the same principles and techniques and are equally adept in applying these anesthetics.

That said, within the ranks of anesthesia care givers, nurse or doctor, there are individual differences as to technical skills and overall abilities to deliver anesthesia care unrelated to the letters following their name. In my career I've worked with both CRNAs and anesthesiologists who would serve the world better by doing something other than anesthesia. On the positive side though, most of the anesthesia care givers I've worked with are very well trained and equally competent to bring patients safely through their anesthetic experience.

Just so you know, there is a new participant coming to the head of the table to deliver anesthetics; the AA, anesthesia assistant. Proving that you don't have to have particular initial after your name to give anesthesia, but you do have to have equivalent training.

If you take anything away from this minimalist introduction to the administration of anesthesia, I would ask that you remember this sentence that I tell everyone of my patients:

"I'm going to stay here with you through the entire case, keeping you safe and secure, and making sure you receive just the right amount of anesthesia, and when the surgery is finished, I'll wake you up and take you to the recovery area."

The best person to be at the head of the OR bed is someone trained in anesthesia who cares about your well being above all else, for those precious minutes in you life.

All the rest is political posturing

Au revoir MMH

With a twinge of sadness I turn over the calendar leaf to Saturday the sixteenth of January 2010, ending my one month-turned –to-one -year assignment as a locum CRNA at Massena Memorial Hospital.
After 34 years of serving my hometown (Ogdensburg) community hospital, I embarked on the path of a traveling anesthetist. Serendipity (and Staff Care) placed me just 47 miles east of my home; in Massena, NY. This was a perfect assignment for my transition from the fragile security of a full time employee to the on- your- own world of Locum tenens (A healthcare provider who is serving as a temporary relief or substitute).
From the first moment that I stepped foot in the hospital there in Massena, I was welcomed and treated like family. To be fair, my brother, a MMH employee, had just recently transferred to the dialysis unit after having served in the OR/endo unit of the hospital. And that certainly paved the way for me to some extent. In addition, a friend and co-worker from my former employer was also doing a week of locum relief in the OR at Massena Hospital at the same time I was starting, further easing my initial trepidation that is natural when starting a new job. No matter how comfortable you may be with your skill level, starting a new job brings with it a normal increase in nervousness. By the end of the first day I knew I was in the right place!
This essay, then, is my thank you letter to my family at Massena Memorial Hospital. And truly a family it is, for it’s not just a building but a group of people who are warm, generous and caring. The high morale at MMH reflects well on its leaders: Charlie Fahd II, Sue Beaulieu, Mark Brouillette, Jonnie Dorothy, and others I’ve yet to meet.

I know I’m going to omit some folk’s names and by no means is that intentional. I want to mention all the people who helped make my stay rewarding. Thursday I was sitting in the ASU and making a list of people’s names who made a positive impact on me, and soon I had over 60 names and knew I’d inadvertently forgotten some, for you see every single person I met whether it be walking in the corridors or in each department, every single person I met extended a smile and a Hi, hello, good morning, how are ya etc., and etc. Every single person contributed to giving me back my joi de vivre. It had been awhile since I looked forward to going to work every day.

It’s my habit to get to work early; usually 45 minutes or so. It gives me time to collect my thoughts and get mentally prepared for my day. I get changed into OR scrubs check the schedule for my assignment, and then go down to the cafeteria for a cup of coffee (1 free cup a day to employees.) Back in the OR break room while sipping my coffee I usually do the daily newspaper crossword puzzle, (gets the intellect revved up.) And then go into the OR to set up my equipment and medications for my first case.

In no particular order, the people at MMH who I’m happy to say made me smile everyday!

On one Monday morning shortly after starting work a MMH I went down to the cafeteria for coffee. There at the coffee counter was a tall young lady, who, when she saw me said with a big smile: “Good morning. That was a nice article you had in the paper yesterday about CRNA Week.” “Thank you”, I said, and good morning to you. What’s your name?” “Katie Helmer” she said. Out of the kindness of her heart, Katie Helmer took the time to compliment the new guy. I was impressed.

Massena Memorial Hospital



Quality Inn Massena, NY. My home away from home when I was on call.

The list is long and will require at least one more post, maybe even two. I want to introduce you to the family at MMH who adopted me with open arms.................................

to be continued:

Today is the first day of my last week in Massena.
One week from today I'll be doing what I do in Syracuse.

Epiphany

The 12th day of Christmas.

One well chosen-word or one well-chosen
line of poetry, which brings the listener peace,
is better than a thousand spoken in vain.

One verse of the Buddha's teaching,
Which is certain to bring the listener peace,
is better than a thousand spoken for no reason.

8. The Thousand, Verses 100, 101, & 102

What does it matter, the new year, the old year?
I stretch out my legs and all alone have a quiet sleep.
Don't tell me the monks aren't getting their instruction.
Here and there the Nightingale is singing;
the highest Zen.

Bankei

# 196 New Leaf

Today's prompt immediately brought to mind a cascade of thoughts related to New Leaf : turning over a new leaf, New Year's resolutions, changing unproductive behaviors of the past, and quite literally, the budding leaves of spring. I don't usually make New Year resolutions but I'm going to make an exception this year. Do not read any Sunday Scribblings posts before penning (typing) you own. Until I read Lucy's (#17) Sunday Scribblings blog post the idea of a leaf referring to the page of a book or magazine hadn't come to my mind.

The leaves of spring are a ways off, at least a few months; time enough to devote current thought to ideas of turning over another kind of new leaf. Besides if one were to actually turn over a new , say Maple, leaf what would be the adage to follow? Of course the leaves of spring, being harbingers of rebirth and renewal, give us pause to reflect and renew any pledges and resolutions we may have committed to at the beginning of the new year.

< So with Lucy's help I turned over a new leaf in my brain and decided that the pages of a calender could just as easily be referred to when considering a New Leaf. I like calenders. In fact I like them so much that there are usually 5 or 6 wrapped and under our Christmas tree every year with my name written on the tag.

I used to have one of those big desk calenders, you know, the ones that measured 16" X 20" with the 2 1/2 inch square boxes for each day. They were great for planning, and also for doodling and at the end of a year they provided a history of the past year. Since I started blogging and using all the other new fangled electro-gizmo's to keep track, not only of birthdays, appointments, and honey do lists, but also of my tasks and thoughts, addresses and phone numbers as well as email addys and miscellaneous musings, I've found myself not in need of the desk calender.
You might be thinking, or not, or you may not have gotten this far before out clicking to the next blog; with all of these electronic day planners why do you still have so many calenders?

Well, since you've stayed this long, let me expound: Calenders today offer so much more than just a way to keep track of which day it is. I remember back when I was growing up finding the Currier and Ives prints on the calender in Aunt Nellie's kitchen fascinating. Later on , besides having bucolic scenes on their pages, calenders might have pithy sayings, adages, proverbs and any number trivial quips.

Slide forward to today and you can find a calender for any interest. And at page-a-day calenders, if you can't find a calender to fit your interest they offer to make one up on special order just for you.

For me calenders offer daily inspiration, prompts if you will, to direct my thoughts for the day; to help to see the glass as half full no matter what. They keep me positive. I figure if I keep inundating myself with positive thoughts over and over, day in and day out, that soon I'll be the positive change I want to see in my world and yours. So every day; a new page, a leaf, is turned and I'm off on another exciting adventure; my day!


This is a new calender for me this year and I've placed it right here to the right of my computer. Are you kidding me? Every day I'm greeted with 10 things to be happy about. This is so cool, I'm tempted to peek at tomorrow's list tonight. Believe you me these aren't things I'd normally be thinking about in the morning, maybe not ever. So you see what I mean about practicing? At the end of 2010 I'll have turned over 365 new leaves and been happy about 3,650 new things. Holy-Moly-Man what a gift that is.

But wait, that 's just the beginning; I haven't even gone out to the gym yet.

My gym is in the 900 sq. ft. 2nd floor over my garage. Therein you'll find most any kind of torture device known to modern man for getting one into well enough physical condition to live to be a healthy 100 years old. Oh, there is more: a Buddhist altar for meditating in front of while lotusing (neologism?) or stretching or self hypnotizing or just listening to a Gregorian choir chanting over the stereo. (just in case you want to extend life even longer ). Even without calenders, every morning that I enter this sanctuary is like turning the page to the next piece of my life.

But in fact the gym does have calenders. There are usually no less than 4 calenders in the gym.


For a number of years the yearly edition of 365 days in France calender hangs to the immediate right of my desk. On my desk is always the page-a-day calender; ZEN.
Imagine going to France every day and being Zen about it! January is devoted to Le Cote d' Azure....what a way to spent January, jheezsh.

There is this year a calender devoted to Yankee Stadium, which my wife gave to all her boys, me included. And of course there is the yearly free calender given out by our fuel oil distributor; Spilman's Morristown Fuel & Supply. This calender depicts scenic views of spots across New York state and serves to please aesthetically and to remind us of our state's history; refresh our memories.

Every day of every year that you breath there is a new leaf to experience, of this I'm perfectly positive even if I'm not positively perfect. But everyday that I open my eyes I get another chance to practice.

If you want more new leafs then pop over here (just click).


Happy New Year to All: old friends and new, real and imagined.

It's that day again. That day of the year set aside for the making of resolutions, resolutions to modify our behavior in order to improve our future lives. Many New Years Days have come and gone without my making any resolutions. Early on in my life I suppose I jumped on the band wagon of cultural commonality and made a list of promises to change my ways. Inevitably this was a Rx (prescription) for failure; "I'm going to lose 571 lbs by Feb. 11th or the 28th at the latest, by strictly adhering religiously to a Tibetan monk's diet." Then, if I even dared; stepping upon the scale to find that I'd gained 571 pounds.

New Years day does offer us an opportunity to reflect back on the past year/years and see if we can learn anything from our successes and faux pas.

Failure is a marvelous tool for learning. Without failure it's likely we'd not make any advances on any level (nothing ventured etc.). But to make a list of things that experience tells us is doomed to fail, is akin to repeating the same ineffective behavior of the past and expecting a different outcome. I've seen that as a definition of stupid.

So, no list, mental or written, of new year's resolution for me.

Did I learn any thing last year? Let me think, in no particular order;

No matter how many years pass I am capable of learning something new. I took my first hair raising roller coaster ride; with my grand daughter and learned that I can still experience fear.

The birth of a new grand child can bring the same exquisite joy that came with the birth of my own children; maybe more.

I've learned that being nice to people is a good thing. A smile almost always gets you a smile in return.

Today I learned not to interrupt a blogging post to go to friends house for a brunch including mimosas and expect to finish the post later!

P.S. It's OK to take advice from you children.