Moving on...

Well, it's been a week since Bloomsday, and I planned on running after a few days' rest. But then I got sick, and I've been out ever since. I'm hoping to get in a short run today, if I don't cough too much.

School has been busy, and the scene is changing for my class. This week we became "seniors" which means that instead of being with a CRNA for every case all of the time, two of us are supervised by one MD, which of course means that we spend most of the case by ourselves in the OR. It differs from program to program how this is done. Some programs have this kind of supervision (2:1) from early on in the clinical rotation. Many others never go to 2:1 at all. I like how our program gets us a good clinical foundation before giving us an entire year at this supervision level. Our graduates are always able to start working right away upon graduation, with no lag-time for getting used to working on their own. Still, at 2:1 we have the MD there at the beginning of the case and at the end, and they come in periodically to check on us and if we call them with a problem. They are generally pretty vigilant about making sure we are supported, especially in the beginning. And it's the only way to learn how to administer an anesthetic on your own, making those moment-to-moment decisions without someone behind you putting in their 2 cents.

We've also been in OB, placing epidurals and doing anesthesia for C sections, which is pretty fun, and in pediatrics, which we have been doing for a little while now. The class above us just graduated on Friday, and we had a big banquet and ceremony for them, which was a lot of fun. My hubby helped put together a nice slideshow presentation for them which was a big hit, although he couldn't actually attend with me. And now we are the senior students at school. It's hard to believe, and yet I don't really feel like the last 17 months have exactly flown by.

I am struggling with about 7 pounds still that I can't seem to lose. I gained a few more in DC but have managed to shed a couple of them. I'm trying to get my eating back where it should be--less sweets, more protein. It's the snacking that kills me. This far out post-op, I think it should be about having a daily maintenance plan for eating, not going on a "diet" to lose weight and then changing our eating back. That's the kind of thing that caused the overweight in the first place. So I'm trying to just cut out the sweets and snacking. It's difficult, especially when stressed. But it's something I have to conquer if I want to maintain my weight loss, and reach my ultimate goal.

Yesterday I worked my first Saturday shift, and we were quite busy. Saturdays we do mainly emergency/urgent cases. My last case was a man with an incarcerated hernia, that is, an opening in the muscle wall of his abdomen that created a pocket for his abdominal contents to leak into. He was having pain because part of his bowel was in there, and starting to have its circulation compromised. I calculated his BMI at about 59. This presents a problem for his safety both in having the surgery itself--it's a much more complex surgery at this level of morbid obesity--and in receiving the anesthetic. I was unable to intubate him (the anesthesiologist could though) despite doing everything I've learned to do to optimize my view of his airway. Once anesthetized and in position, he was very difficult to ventilate. The surgeon who performed the surgery was on call for general surgery, but most of his day-to-day practice is bariatric surgery (mostly RnY). One of the techs asked if he'd be doing a RnY on this patient later, but the surgeon said that the patient seemed to have no idea that his weight was even a problem. Of course, we know that if the patient doesn't accept any ownership of the problem of morbid obesity, bariatric surgery isn't going to help in the long run. He reported having excellent health, even though we discovered that his blood pressure was quite high and he almost certainly should be sleeping with CPAP at home, at the very least. I am sure he doesn't see a doctor very often if at all, and if he's anything like many of us who had bariatric surgery, it is at least partly because he doesn't want to hear them lecture him about his weight. The patient seemed like a really good guy, and I thought about all the reasons he might not be taking care of his health, and felt really badly for him. Surgery went fine, though, and he was starting to recover well when I dropped him off.

Today is a lovely day, and I'm hoping to go for a run. Happy Mother's Day, everyone!