Anesthesia school is a 2-year marathon.

When you feel tired and beat up, you just have to keep going. Just keep going to clinical.

Anyways, I just wanted to announce a couple of things.

First, I’m done with my second semester and I’m onto my third semester. I took a week off for a family vacation in between the semester. It was definitely much needed. This semester is supposedly better in some ways. For example, there are less OR jitters compared to the 1st semester. But going to a new clinical site presents its own challenges (a new anesthesia machine, new charting system, different drug dispensing, different protocols, different equipment, different labels, different drug vials and doses, new names and faces, not knowing where anything is, new surgeons, new procedures, different patient population, etc). Now we’re going strong by going to clinical 4 days a week and 1 day of class (and my, that day is 10 hours long!!). When I look back at what I knew in October versus now, it is a huge difference. It’s incredible.

This semester there’s a couple of focuses: research, emergency management, regional anesthesia. I’m pretty pumped. I’ve come far but there’s still much more to go. Resiliency has never been more important than now.

Second, as of yesterday, I’ve done 100 successful intubations. It’s a great feeling.

Third, thanks to everyone who’s been writing me positive messages about the blog, supporting me through the flashcard purchases, and anyone who’s enjoyed reading my blog. I see that each month there are more visitors and visits than the next, despite me not updating it as frequently as I used to.

Fourth, happy nurses week again.

Fifth, congrats to those who got into the UM-Flint nurse anesthesia program. It was nice meeting some of you and I’m sure we’ll meet again soon enough!

I have to go now. Until next time,


crna week button large image


This past week was CRNA week. And since I’m training for this profession and it’s been awhile since I’ve posted, here it goes.

I believe that most of my readers know what a CRNA is: a certified registered nurse anesthetist. While there are some hospitals or surgery centers that only use anesthesiologists, the majority of hospitals in the United States also use or contract CRNAs. In some locations (especially in rural areas), the CRNA is the sole anesthesia provider.  CRNAs are masters or doctorally prepared and thus go under intense full-time training typically from 24-36 months, depending on the program. They must have at least one year of critical care experience and often  also take the GRE and CCRN before applying.

Currently, there are over 49,000 CRNAs in the US providing anesthesia in all settings and all kinds of surgery. Since I’m currently in Michigan, I know there are about 2,500 CRNAs practicing in Michigan alone.

I have to admit as a student registered nurse anesthetist, the program is tough and requires my full attention. Everything I learn in class is applied during clinical. Each day for clinical requires a full preparation, which requires a few hours of reading the night before, considering how each anesthetic is personalized for each patient, depending on their health history, anesthesia history, surgical history, medication/drug history, weight, height, labs, last time eaten, airway assessment, allergies, patient’s preference, and more. The expectation is that from day one that you’ll be an independent anesthesia provider and thus doing preoperative assessments (full head to toe assessment; are they optimized? What kind of anesthesia is appropriate, if any?), induction, maintenance, emergence and post op are all a part of the CRNAs role.

During the first semester, I felt this level of anxiety in my life that I had never experienced before. Even the smallest thing that goes wrong would make me question if I was able to do this program. Usually, if I did something wrong, I would tell myself that I did it wrong, and how to prevent that mistake the next time. However, some mistakes will be drilled into your head, which only furthers the anxiety (though I know the program is only hoping that it won’t ever happen again). Before each night, I could feel my ear pounding against my pillow. When I woke up, I was in sweats, waking up from a nightmare that I did something wrong. Then I’d force myself to eat at 4 am otherwise I knew I’d be hungry during the morning rush (because you never really know when you’ll be able to eat). Each day you have a plan, but you’re never sure exactly which plan you’re going with or questions you’d get asked that day. Sometimes I am prepared enough and other days I feel defeated. There’s a high level of expectation that you should know more than what you’re taught in class and that was a part of what makes it tough.

As the first semester waned and the second semester started, I compared what I knew back in August with what I knew at the beginning of January. In 4 months, I poured myself into these three 2-inches worth of notes and powerpoint. It’s impressive how much more I know now.

It’s been a month since the second semester started and I can say that I’ve reached a milestone: 50 intubations via laryngoscope today. From a year to 80-year-olds, orthopedics, dental, GI lab, plastics, burns, laparoscopic, c-section, healthy to very sick and so much more, it is  incredible the range of patients that I’ve had the privilege to give anesthesia.

I’ve learned much but still have much to learn.

I have to say that I couldn’t do this program with the support of my family and friends and just as importantly, my classmates. They truly understand the turmoil that goes through the SRNA. We get each other’s backs and study together. How great is that.

The last thing before I end my update — considering that I’m in Flint, Michigan all the time now, I feel that I should address the water crisis. Drinking high amounts of lead, especially among kids under 6 whose brains are growing, will cause brain damage. I don’t know the effects among adults, but I’m sure drinking unsafe levels that over 1000x the acceptable level over a long period of time is not good for you.

It is true that people are drinking only bottled water. And bathing in bottled water (because it has caused rashes in many people). It is unfortunate that Flint’s emergency manager refused to acknowledge that Flint citizens’ water was affecting them negatively. The Flint City Council had voted to switch back to the Detroit River water but the emergency manager had vetoed this vote and denied this demand. It is terrible that only after scientific research done by a pediatrician at Hurley Medical Center that this problem becomes public in October 2015, before becoming an emergency in January 2016.

It is true that Flint has been devastated but now it is just so much worse. The majority of people who work in Flint travel from another town because people don’t feel safe. People don’t feel safe because there’s a high crime rate, most likely due to low income (the average person living in Flint makes $24k, which is HALF of the national average of $48k). When there is simply not enough funds to live, people will commit crimes to make ends meet. The low income is due to a lack of companies willing to be in Flint. But there’s a lack of companies because they don’t believe Flint has people capital. It is a terrible, terrible cycle. Having crazy high amounts of lead in water just adds fuel to the fire. Even fewer people will want to live in this town.

I’m disappointed that ‘saving the Michigan state funds’ or money, was more important than providing a safe source of a basic need: water. Money was more important than the wellbeing of over 100,000 people in the USA. It is hard to believe.

And one more thing — thank you to everyone who’s supported me on this website. Until next time.


Michigan vs MSU

All this week, there’s been so much hype about the Michigan vs MSU. With Coach Jim Harbargh at Michigan, Michigan football is doing better than ever. Usually, I don’t really follow but my fiancé is a huge fan (he listens to podcasts and even submits questions via Twitter, haha) and now I’m a student!!

Anyways, Michigan has been dominating the last 4 games although MSU has won all five games undefeated thus far.

Apparently people all over the country are driving or flying in, staying in the cheapest hotel almost 30 minutes area at $250, with the cheapest tickets going at $175 this year (unless you’re a student who got season tickets).

Guy Fiori is going to be at Meijers this morning. “Game Day” is happening at the Diag. Somehow my friend talked me into going so I woke up early to get some studying done before I take a morning break and start back up in the afternoon.

It’s gonna be a lot of fun.

Speaking of studying, there’s a lot of new material. There’s a final exam in physical assessment and a principles exam coming up on pediatrics, fluid and electrolytes, blood products, and part I of the anesthesia workstation (yes, I can draw the oxygen molecule from the hospital outside, through the entire machine, and to the patient circuit— wow!).

I definitely feel on edge at a much higher rate than ever before. I’m usually a pretty calm person but now more than ever, I can feel my heart racing and getting anxious. And that’s almost everyday. I try to calm my nerves by either studying more, or setting time aside to go for a walk or watch some funny TV. Taking care of myself is probably one of the most important things I can do to endure through the program.

I learned this week (amongst other things), that a “sugar high” isn’t really a sugar high. As a tasty candy bar, full of “simple sugars” or glucose or monosaccharides readily available for insulin to act on, glucose is too quickly shoved into cells, causing a hypoglycemic effect. The alpha cells in the pancreas senses the hypoglycemia and releases glucagon. Epinephrine is also released from nerve endings and adrenals. Both glucagon and epinephrine go to the liver, which then undergoes glycogenolysis, breaking down glucagon into glucose and releasing it back to the bloodstream.

However, image the little kid full of epinephrine, setting off the sympathetic nervous system, causing him to run around like crazy during recess or banging his head against the wall. So a “sugar high” is really caused by “hypoglycemia” that’s induced by our more primitive insulin that floods our bloodstream when sensing a huge amount of glucose. If instead the ingested glucose was complex such as a starch, then our insulin is a much better match, releasing the appropriate amount of insulin without going overboard.

I did a few spinals this week (how cool and amazing it is!!) but next week I will try to do more general cases. All right, enough updating. Until next time.


PS. I know the first round of interviews is coming up so I just want to say good luck to anyone who’s interviewing at UM.

PSS. The double rainbow outside my window on Thursday is the featured photo. Nature is beautiful.

Clinical starts 

The last day of simulation was on Friday (can you believe that it’s been a month since I started?) and clinical starts this week! I’m excited and nervous.

First week of exams are over. Now we just have 1 exam each week until the end of December. 

The things we learned this week:

  • Proteins
  • Pediatric overview
  • Second gas effects

What I learned in clinical:

  • Propofol can burn, especially when the IV is in the hand or forearm. Unless contraindicated, give the lidocaine!
  • Don’t tell them that it won’t burn. Because it just might. 
  • Make sure the IV is working pre-op.
  • Always be ready to change location on the fly and be prepared for general anesthesia when doing a monitored anesthesia care (MAC) case.
  • Have all the drugs looked up, patient history, and be able to discuss the plan with the CRNA. 
  • Follow through with what you say. 
  • Be confident with your preoperative  assessment. Hit all the major points. Make sure you know their anesthetic history. 

Ok, here it goes. 

Also, the super moon lunar eclipse was cool. Though I may only feel this way because I’m not working today. Usually on a full moon, it gets just a little crazier in the hospital. I’m not sure if it’s just a coincidence.  

Here’s the supermoon with the eclipse starting. 



At 10:15pm EST, the moon turns blood orange. So cool! What a beautiful night. 


This week was interesting. I remember first seeing this video 6 days ago with all this positivity about a Miss America contestant, Kelley Johnson, talking about her experience as a nurse. I thought that was such a different take on what it means to have a talent. It’s not the typical talent showcased on Miss America  so I was actually glad that nursing was explained as a talent.

Then, The View happened. Although I don’t think that Joy and Michelle, the talk show hosts, went out of their way to make fun of nurses, they were simply ignorant of what nurses do. Nonetheless, it was hurtful to hear that Miss Colorado was just “reading her emails”, wearing a nurses “costume” and was questioned why she was wearing a “doctor’s stethoscope,” which really is just a stethoscope.

However, I can see how the hosts could be misled. As a relatively healthy person who hasn’t muddled in the healthcare field, you may see the nurse get a set of vital signs, ask for a history, and maybe give shots. You may not really see the difference a nurse makes in that scenario. Instead, you’ll see physicians who will use their “doctor’s stethoscope” to listen to you.
It’s only once you’re sick in the hospital that you see the nurses work their magic. I know that was what got me hooked. The compassion, skill, listening abilities, tough love attitudes… I knew I had to be one.
Regardless, Facebook blew up with #nursesunite and the group “Show Me Your Stethoscope” grew over 600,000 members in a couple days. Memes popped up all over and everyone in the healthcare team supported nurses. It was an amazing outrage.
doctor's stethoscope and nurse's costome
And here’s another:
And another:
insult nurses
 But this post is my favorite:
nurses unite
On Wednesday, The View attempted to apologize, but it was a half apology where they blamed the nurses for not listening to the content. Except that nurses are actually really great listeners and know that is not how you apologize. You have you owe up to your mistake and not blame others. People were still not satisfied with the response.

During this time, Johnson and Johnson and England’s Best decided to pull their advertising from The View. Considering how much J&J supports nurses, I actually appreciate that effort.
On Thursday, The View and NYU decided to have an educational segment about the role of nurses. Rather than playing the blame game, it’s better to educate.
 socrates the secrete of change

On Friday, the segment focused where nurses are and have made a difference. The NYU Stimulation instructors explained more broadly about what nurses do and described the educational background required for a nurse but I wished it was a bit more personal where they describe a more complex story that involved a nurse who played various roles and how they lead care. This would open people’s eyes into what nurses do.

You don’t really know what nurses do until you’re under their care. You’ll see providers come and go, but your nurse will be there for you. They will explain to you what’s going on when things get scary, work to allay fears, give medications, help you do almost anything that you can’t do, push you to do better, teach you about your medications and how you may have to change your life, make sure you’re safe from any kind of errors, act as your PT, OT, RT, speech therapist, and so much more. But you won’t even know they do all those things until you need them.

nurses do a lot

Michelle and Joy genuinely seemed interested and did seem to feel remorse for what happened. Raven, however, looked really bored who did not talk. It would’ve been better if she had engaged with her body to at least seem interested.
Before the end of the segment, stethoscopes were given out. I thought that was unnecessary because, as Joy shortly demonstrated after receiving one, she and other lay people do not know how to use one. Stethoscopes are an important medical tool, not a gift given to those who don’t know how to use one.
At the end, NYU recruited some of their nurses and nursing students (because I recognized those purple scrubs) to come out and support the educational segment.
Even if this is done as a publicity stunt to bring back the primarily audience to watch the show, I’m glad The View did it. At least they addressed the source of concern and hopefully they realize that you cannot just say anything and expect that people will accept it.
Ignorance is not always bliss.
It was amazing to see this kind of outpour of support and willingness unite on this. I hope that, despite our need for instant gratification for a desired effect, that nurses can unite on other things just as strongly.

Week 3: First Official Week 

Flexibility. Even in the first week, not everything went according to plan. But it’s about the willingness to adapt and go with the flow. 

The things I learned this week:

  • The Larynx — the cartilages, ligaments, muscles, and how all of those things work together and affected by anesthesia. And what are likely problems that can occur and how to respond. 
  • OR — checking the anesthesia machine and table top set up. 

This coming week is the first full week of class so here it goes!


Week 2: Orientation is completed

The second and final week of orientation is finished. The most important aspect that I got out of it was the wellness talk. I believe that in our lives, we continually try to find wellness in all aspects of our lives without even really realizing it.

There are six pillars of wellness

  1. Social – this is how well you get along with others and your environment. 
  2. Physical – this is how physically fit you are by exercising and eating well. 
  3. Emotional – this is how well you’re able to express your feelings. 
  4. Spiritual – this is understanding the purpose of life, being self aware and open. 
  5. Intellectual – this is the desire for lifelong learning. 
  6. Occupational – this is applying yourself to something that’s meaningful and rewarding. 

We all try to obtain this delicate balance. When one aspect suffers, we either go all overindulge in one way or hide in our shell. One way to gauge vulnerability to stress is through this short test. What I learned was that these are ways to help me relieve stress for the upcoming years. 

Score 1 for Always True 

Score 5 for Never True

  1. I eat at least one hot, balanced meal a day    
  2. I get 7 to 8 hours of sleep at least 4 nights a week     
  3. I have at least 1 person who lives nearby from whom I can ask a favour   
  4. I exercise to the point of perspiration at least twice a week     
  5. I do not smoke   
  6. I drink fewer than five alcoholic drinks a week     
  7. I am the appropriate weight for my height     
  8. I drink fewer than two cups of coffee (or tea or cola) a day     
  9. I have a network of friends, family and acquaintances on whom I can rely    
  10. I confide with at least one person in my network about personal matters    
  11. I am generally in good health     
  12. I am able to speak openly about my feelings when angry, stressed or worried     
  13. I do something for fun at least once a week    
  14. I recognise stress symptoms     
  15. I take quiet time for myself during the day    
  16. I have an income adequate to meet my basic expenses    
  17. I spend less than an hour each day traveling to and from work     
  18. I am calm when I am kept waiting/stuck in traffic/late for an appointment?     
  19. I have regular calm conversations with the people I live with about domestic problems, e.g., chores, money and daily living issues     
  20. I never try to do everything myself   
  21. I never race through a day     
  22. I never complain about time wasted and the past     
  23. I feel organized and in control     
  24. I am able to organize my time effectively    
  25. I recognise when I am not coping well under pressure     

Anyways, I picked the quote about courage this week because we’re told over and over again about the difficulty of this program. But I feel that no matter how many times it has been emphasized, you won’t be completely ready for it. The only way is to do it. So here it goes. 


Stress level:



Week 1: The First Week of Orientation

The theme of the week: Anesthesia school is having your mouth wide open, turning on the firehose, and swallowing every last drop. 

Of course, I haven’t experienced this quite yet — this first week consisted of the following:

  • Meeting classmates, and those in the other 4 anesthesia programs in Michigan
  • Feeling that being a part of AANA and MANA is vital to the profession
  • Getting nervous/excited
  • Sitting in business casual clothing (as opposed to scrubs)
  • Getting acquainted with the program handbook, the hospital, etc
  • Buying program shirts/sweatshirts (yes, this is important)

And aside from school, I

I feel that I still need to establish the following:

  • Wellness — having a 80% healthy diet and a health routine that’s worked into our study / class / clinical / sleep schedule. My roommate introduced to me Yoga with Adriene. She’s down to earth and moves nice and slow, which is good for a beginner like me.

Anyways, it’s probably also good to know that our class is going to help each other out. I’ll try to update this blog once a week with at least one thing I learned that week. These next 24 months are going to fly.


Stress level:


August 1

There’s less than 3 weeks left before school starts. I finished my last day of work, handed in my garage key card, cancelled my gym membership, and transferred my address from NYC to Michigan this past week. I’ve met with several friends for the last time before I move. I folded all my clothes and placed them into the suitcases. When I looked up and saw a blank white space, my vision started to get blurry and I felt a stream run down my face. I knew this day would come and I’m more excited than anything. 

What I learned and experienced over the last 8 years in NYC is tremedous and something that I would’ve never expected. Sometimes it’s still hard to believe that I’m actually leaving this place now and who knows when I’ll come back. 

Probably the most important thing I found out recently was that I was able to receive in-state tuition, after a 3 month queue and submitting my and my parent’s tax plus more information. 

Anyways, that’s it for now.