Excellent Student One of the things I like about my job is that I get to teach. We have Nurse Anesthesia residents both from the Air Force as well as from a civilian school that come to our hospital for training. These residents are experienced nurses. They have to have experience as emergency room, recovery room or Intensive Care nursing just to start in an anesthesia-training program. They then have to get through two and a half years of grueling training. They cover everything from anatomy and physiology, to pharmacology and of course anesthesia. In the last year and a half they are in a hospital for about 50 hours a week doing cases. This does not include hours of case preparation and study at home each week. When it is all over with they still have to pass a very difficult and comprehensive board examination to become a Certified Registered Nurse Anesthetist. It is very satisfying to me to be able to train the residents. I get to see them progress from scared wide-eyed rookies to confident nurse anesthetists. Yesterday I went into work thinking I was going to have a busy day. I was scheduled to be in the cysto room with seven cases scheduled. The cysto room is a specialized operating room where the surgeon is an Urologist and the cases involve the patients kidneys and bladder. Any time you are in a room with seven cases scheduled you know you are going to have a busy day. You have to be very organized to be able to get the cases done without a lot of delay between cases in able to get everything done. I arrived in the cysto room and was surprised to find all the anesthesia stuff set up already. It turned out I had a resident assigned to work with me and had not known it ahead of time. When I got to the OR she was ready to go. I had not worked with this particular resident before so I watched her closely as we started with our first patient of the day. She is due to graduate next November but after spending the day with her I can honestly say that if I needed surgery tomorrow I would let her do my anesthetic. I spent yesterday watching her do all seven cases flawlessly. She did 5 general anesthetics (put the patient to sleep and placing breathing tubes in their throats), 1 spinal anesthetic and one sedation. I have been doing anesthesia for 14 years now and I do not think I could have done the cases any better than she did. We did seven cases and we finished before three in the afternoon. It is nice to know that I had a small part in her training.

The Prisoner and The Flip Top Forehead I did two interesting cases today. The first was a parotidectomy. That's where they remove a gland from the side of your neck. No big deal I have done them before. It was the patient that made this case interesting. He arrived in the holding area hand cuffed and with leg shackles on his ankles that were attached to the gurney. Two armed correctional officers accompanied him. Fortunately he was very well behaved and gave me no trouble. The officer released one of his arms long enough for us to start his IV but he stood on the other side of the gurney holding on to the other cuffed hand. He then recuffed the convict. One of the officers changed into scrubs and came into the OR with us. He stood out of the way but he watched the convict closely. After the patient was fully asleep and intubated he removed the handcuffs and leg shackles. He sat in a corner of the OR for the whole case. When I asked him why he said it was policy that a guard stay with the man at all times just in case he woke up unexpectedly. I did not ask what the man was in prison for but the OR nurse told me later one of the guards told her to be careful because the man was a lifer. My second case involved a man with a mass around the bridge of his nose. He had what looked like half a donut under the skin across the bridge of his nose. It was hard to the touch. To avoid leaving scars on his face the surgeons did a coronal incision. They shaved the top of his head and made an incision from ear to ear across the top of his head. They lifted the skin and muscle off his skull all the way down his forehead until they got to the mass between his eyes. When the surgery was finished they replaced the skin on his skull and when his hair grows back it will hide the scar. By the way that is how they do a browlift or facelift only they remove some of the skin and pull what is left tight before they resew it. Any ways it was an interesting day.

My Son The Actor Tonight Thumper and I got to see The Boy in a play. We got to go to a dress rehearsal of Shakespears Twelfth Night. For those familiar with the play The Boy played the role of Malvolio. It was an excellent production. It was done with minimum props and basic costumes so you really paid attention to the acting. All of the young actors did a great job but only the boy appeared on stage in bright yellow fishnet stockings. He did a great job playing a character who starts out very stuck up but who goes a little crazy to win the women he loves unaware that he has been tricked to make a fool of himself. We had a great time and can not wait for the next production. It makes me sad that we did not get to see some of his other shows. He played the mad hatter in Alice in Wonderland last year and we only got to see a picture of him in costume.

Another Reason Not To Do Drugs I worked the evening shift last night. I did a case, which was the perfect example of why doing drugs makes people do stupid things. My patient was a man around 40 years old who decided he was going to sniff some spray paint. I do not know anything about sniffing paint but for some reason this man tried to heat up the can of paint first by putting it on the stove. Maybe heating the paint can makes it work better. Unfortunately for my patient in this case the paint can exploded in his face. The damage to the left side of his face was extensive. His left eye was unsalvageable and he has multiple fractures to the cheek and jaw. As he was unresponsive when they brought him up from the Emergency room it was still undetermined if he had suffered any brain damage. There is a part of me that wishes that people who were just starting out doing drugs could see my patient last night. Maybe a few of them would think twice about getting started. On a happier note Thumper really likes her new toy. Her red toy was on its last legs when she found the Carmax add for the new one. We went up on Thursday and after four hours (by the way I absolutely hate car dealerships) the car was hers. Of course it rained all day Friday so we didn't get to take it out. Yesterday however was a beautiful day and we had it out in the morning before I went to work.