CRNA Week

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.

Jessica

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.

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. 

Jessica

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.

Jess

Stress level:
two

 

It’s getting real

Since I got accepted into the nurse anesthesia program at UM Flint, it’s been an exciting time in my life. I went on my first cruise, got engaged, joined a Community-Supported Agriculture (CSA) and started to really think about what this program will entail. Recently, the previous class invited the Class of 2017 to a BBQ before school starts. For me, it means it’s going to start soon. The program director sent information about what to expect (school = your life for 2 years and don’t let anyone expect you to help around the house but still have at least one evening off to decompress and hang out with loved ones), review material especially in math calculations, the autonomic nervous system and some medications we’re already familar with, and the people I’ll be with for the next couple years. 

Speaking of which, I didn’t expect my picture from the interview to go up. I wished I straightened out my hair a little better but hey, it is just a picture (see above). 

I appreciate that we’re paired up with a mentor from the Class of 2016. It makes it easier to ask questions since they just went through it first (or junior) year themselves.

Sometimes I’ll wake up nervous — but I haven’t even started yet. Then I’ll remember that it’s such a privilege to even have this opportunity. I’m not sure if anyone is ever ready for the massive amount of information that’s expected to be memorized and applied, but here it goes.

One thing I really don’t like doing is writing scholarship essays, or really any essay that involves describing ‘how amazing I am based on the criteria that you’re looking for.’ But it’s a necessary evil. One thing I don’t understand is that if we’ve already submitted our application with letters of recommendation to get into the program, why do we need to duplicate the process of submitting additional letters of recommendation when applying for scholarships? Regardless, I’m thankful to have a NYU faculty member who is not only super supportive of me but also fast in response. 

I’m thankful for everyone who’s supported me. Because life isn’t an individual event. It’s comprised of many people. So thanks.

I’m excited to start this new chapter in my life. There’s 2 and a half months left before school starts. Two more months to save money before I’ll have zero income. But it’ll be worth it.

I got into the University of Michigan-Flint / Hurley Medical Center Nurse Anesthesia Program!

official.umflint.logo_I’m really excited to say that I got into the University of Michigan-Flint / Hurley Medical Center Nurse Anesthesia Program. I am proud of my accomplishments and thankful for everyone who has encouraged me and helped me along the way.

I’m inspired to write about my journey — past, present, and future — by other blogs about Certified Registered Nurse Anesthetists (CRNA) schools (such as http://studentcrna.blogspot.com/ and http://lifectent.blogspot.com/) and the Umich Med School blog written by multiple students. My hope is to give insight into this career path and encourage those who may be interested too.

Like many others, I have varied interests, but healthcare was always in the forefront of my mind. I grew up knowing that I wanted to heal the sick and that I wanted my presence to truly make a difference in people’s life everyday.

I first went for a biology degree for pre-med. But unfortunately, as I started to explore medicine as a career, I was put off by it. Sure, a lot of friends continued on and I’m proud of them. Some decided that it wasn’t for them either. I started to explore other healthcare fields. I found my place in nursing. I was most excited when I found out about the accelerated nursing programs because it truly changed my life. Before I finished my biology degree, I took several prerequisites for nursing schools that I was interested in (because unfortunately they all differ).

After I graduated from nursing school, I knew that I wanted to go to graduate school. I took a couple of graduate courses through NYU’s dual degree program while I was working on telemetry. I was interested in nearly all the graduate nursing fields — nurse practitioner (acute, primary, pediatric, family), nursing informatics, nursing administration, and nurse anesthesia. But it wasn’t until I entered the intensive care unit before I started to really take my preparation seriously. At this point, I debated becoming a primary NP or going into nursing informatics or nurse anesthesia.

I already saw what a difference nurse practitioners do but I didn’t know if I really had it in me to do anesthesia. Life in my hands– day in and out. But I met a few UM alumni who told me that I would do a great job. I shadowed them over the summer, and saw their autonomy and teamwork abilities. I had almost all of the credentials to apply and their encouragement made me believe in myself.

I started my process of looking into schools to apply.

  1. Where is it located?
  2. Do I meet the requirements? If not, which ones are still missing?
  3. Is there an information sessions to learn more about the program?
  4. When is the due date? When does it start? How much does it cost?

I started attending information sessions in July. I went to UM-Flint information session in October. My advice is to bring transcripts. This kills two birds with one stone — (1) an opportunity to speak to the head of admissions and (2) to find out if your prerequisites meet the school’s standard. Learn how the school chooses students. Some may emphasize that three years of critical care experience is essential and any ‘outside of work’ experience is crucial. Others say that ‘you may pass all of the didactic courses but if you fail the clinical aspect, then you’re not cut out for CRNA.’ While that’s true, when I hear that comment, I feel that the school is more hostile rather than helpful. Just as you’re interested in becoming a CRNA, it is important to learn more about the school’s culture.

At the University of Michigan-Flint, admissions is based on a points system (as are many schools). For the application, objective data such as the science GPA, overall GPA, and GRE score is scored. Thankfully, I was able to submit majority of the application before tackling the admissions essay. In the essay, it is crucial to answer every question in detail. And while the CCRN is not required, it is highly recommended to take it. It shows that you take your education seriously and it helps you prepare for the interview.

At UM-Flint, there are 2 due dates: Early (10/1) and Regular (2/1). I submitted my full application a week before the due date. There was a website to check if all of your required paperwork is submitted and which ones were not completed (I loved this!). The admissions team was easy to work with and answered all my questions. Sometime during the first week of February, I was offered an interview for either February 19 or 20. I picked Friday the 20th. I made some work schedule changes and booked a flight back home. The 3 part interview (exam, panel interview, and OR with CRNA) is also based on a point system– 10 points for each section. The purpose of this is to make admissions as fair as possible (rather than getting in because you know someone on the admissions board).

  1. The exam is composed of multiple choice, fill in the blank, and essay comprising mostly of CCRN and ACLS material. Apparently, I have to work on the cardiac section.
  2. The interview is a panel interview asking typical questions as well as some ethical questions. I highly recommend practicing saying them out loud. I recommend getting the All CRNA School Guide, going over common questions.
  3. The OR time with a CRNA is comprises of short clinical questions on what you’d do in certain situations.

When I walked in, I saw that I was the last person to be interviewed. After the 3 hour interview window, I was driving back home and got the call. I was shocked that they had reached their decisions so quickly, especially since I was expecting to hear back a week or two after the interview. It may be because they’ve already interviewed everyone and scored them on a points system already and they simply picked people starting from the highest marks going down the list. But regardless, I was definitely excited.

Of course, getting in sparked another list of questions to solve. That’s what I’ve been working on since then.

  1. Where will I live?
  2. Who will I tell?
  3. When is my end date at work?
  4. How will I end my lease?
  5. How will I manage my relationship with my sister and boyfriend?
  6. Will my boyfriend stay here or move back with me?
  7. My car lease is almost up. Should I lease or buy another car considering the number of miles I will potentially drive?
  8. Taxes need to be completed. FAFSA needs to be completed. In-state or out-of-state residency needs to be determined.

I also looked up all the clinical sites and put them on Google Maps.

It’s about a nice 1 hour radius circumference from Flint, Michigan. As of right now, I’m planning to stay at home in Ann Arbor but for clinical that is more than 1 hour away, I’ll stay closer.

As for my boyfriend, he will stay in NYC. He’s doing well with his career here. And we’ve had a long distance relationship before back when we were swapped — when he was at the University of Michigan studying economics and I was in NYC. How ironic.

As for cars, lately I’ve leased Honda Civics because they are less expensive and reliable. But it is true — I really should support American Car Companies (Ford, GM, Chrysler). I plan on going to the New York Auto Show in April and hopefully I’ll get a better idea of what car I should buy.

As for saving money for tuition, I’ve been working an extra shift about every other week. Thankfully I’ve saved a bit already in my retirement funds, which can be used for higher education (I need to look into this more).

As for the order in which I told people, I first told my closest friends not from work. Then after the official letter came in, I told my nurse manager (who is really supportive!!). After that, I put it on Facebook. Prior to applying, I didn’t make it well-known that I was interested in nurse anesthesia partly because I wasn’t sure of the reactions I would receive and I’d rather just leave that part off the table. However, since getting in, I’ve received positive feedback. I think that for the most part nurses are kind and encouraging but I guess you never know.

That’s it for now.