Long time, no see

Hi readers of Nurse Jess,

It has been nearly a year since I posted on my blog. Some readers (aka a few junior anesthesia students) have met me and wondered if I’ve fallen off. Nope, I am right here!

Every time I considered posting, an exam, a care plan, paper, or even the limited time off to do nothing, pulled me away. But now I’m back.

I have so much to say and yet so little time to do it. I could write a lot, as I often do, to convey all of my thoughts. But I will try to keep it short to encourage me to post more.

Since the beginning, I’ve done over 700 cases and over 1800 clinical hours. And there’s still 4.5 months left of anesthesia school. It may seem like a lot, or a little, depending on who you are.

That time doesn’t include class days, the preparation for clinical, the preparation for anesthesia school (GRE, CCRN), the intensive care unit hours, the bachelor of science in nursing AND biology. In my mind, it’s been ten years of training. Wow.

I have to admit, the beginning of anesthesia school was tough. What makes the training challenging is at first, you are learning the basics of airway management (intubation, LMA, oral and nasal airway, chin-lift, jaw-thrust, etc.) and the anesthesia flow for each type of surgery and unique to each patient (preoperative, intraoperative, postoperative course). Not only that, but each anesthesia provider (CRNA and anesthesiologist) have their preferences and expectations of you. Even during the short breaks, one CRNA may be ok with your choice, but another CRNA would reprimand the choice. The only thing you can do is to understand their choice (What’s the rationale?). As they say, there are a 1000 ways to skin a cat.

Now, there’s less anxiety and more of a discussion, even as I go to different clinical sites. It’s much easier to anticipate changes and adapt to the circumstance. For example, just today there was a switch in the schedule. Last year, I felt more frantic and had to think about my each step more carefully (especially in pediatric cases when there’s a change in age and weight that require a change in equipment size and drugs). Today, it changed from a two-year-old, 15kg to a 6-year-old, 25kg for ear tubes (*real age and weight are changed). What are the appropriate emergency drug doses I would give? What equipment changes do I need to make? I switched a size 3 to a size 4 mask, and had a 5.5 ETT (endotracheal tube or breathing tube) with a MAC2 blade, and thought –

  • atropine 0.02mg/kg = 0.5mg = 1.25ml,
  • succinylcholine 4mg/kg IM = 100mg = 5ml,
  • epinephrine (1:10,000 or 0.1mg/ml or the big stick) 0.01mg/kg = 0.25mg = 2.5ml.

Anyways, that’s it for today.


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.

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:


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.