Chuck Biddle PhD, CRNA is a Professor Emeritus of anesthesiology at Virginia Commonwealth University and served as the editor in chief of the AANA Journal for 35 years. His anesthesia education & master’s degree are from Old Dominion University and he completed his PhD in Epidemiology at the University of Missouri.
Chuck is one of my favorite people in the world of anesthesiology. He’s one of those folks who have put the time in over decades to develop a true, deep mastery of their profession while at the same time bringing with them a level of authenticity, integrity and humility that garners true respect. He’s a guide. He’s helped countless physician & nurse anesthesiology trainees develop and gain a love of the work we do. And one of the central focuses of his career has been fervently working to understand the things that put our patients at risk and develop research and insights for practice to advance patient safety.
Which brings us to this show.
In this episode, Dr Biddle turns our attention to what happens to patients after they go home from day surgery. We talk about a study his team did at VCU where they sent patients home with pulse oximeter monitors and tracked their course for 48 hours following day surgery.
We talk how novel this idea is in that very few studies have actually looked at what happens to patients following ambulatory surgery and that a certain segment of these patients – those who have obstructive sleep apnea are at particular risk for devastating postoperative complications. Chuck points to Jonathan Benumof’s, MD 2016 article in the Canadian Journal of Anesthesia titled Mismanagement of patients with obstructive sleep apnea may result in finding these patients dead in bed (full article below). Dr Benumof is a world-renowned physician anesthesiology and expert in airway management and pulmonary physiology. He is a professor of anesthesiology at the University of California – San Diego’s School of Medicine. Over the 15 years prior to the publication of Dr Benumof’s article in which he served as an expert witness in litigation cases, he testified on 12 cases where OSA patients died within 48 hours of surgery. In the article, he unpacks each of those cases and provides the following prototypical dead in bed OSA patient:
“A 58-yr-old continuous positive airway pressure (CPAP)-compliant male (170 cm, 120 kg, body mass index 40 kgm-2) with polysomnography (PSG)-proven severe OSA undergoes orthopedic, upper airway, or abdominal surgery under general anesthesia. The patient has an uncomplicated stay in the postanesthesia care unit until discharged to an unmonitored bed without CPAP or oxygen. After receiving small (and within standard of care) doses of narcotics for pain for 11 hr, the patient is found DIB [dead in bed]. Advanced cardiac life support is either not attempted or fails to return the patient to their baseline state of life (Benumof, 2016).”
This episode is one of those discussions that makes you see the work you do in a whole new light and gives you a renewed sense of ownership over making sure you and your colleagues are doing the right thing for your patients. This show is coming out on 28 January 2024 and was originally recorded at VCU’s studio with a table top microphone back in the summer of 2017. I apologize that the audio is a little hazy but the power of Dr Biddle’s research and passion for this topic are still very much relevant to providers today. So with that, let’s get to the show!
This is an incredibly special podcast that I’m thrilled to pull forward from our old show, From the Head of the Bed, to Anesthesia Guidebook.
I love that this episode is number 101 because EKG lead selection should be 101-level knowledge for anesthesia providers, yet so many folks have not mastered this fundamental knowledge as part of their practice. I hope you get as much from this as I have over the years.
Dr Mark Kossick was a full professor of anesthesia at Western Carolina University when my wife, Kristin, and I attended the program and he actually just retired in late 2023 from that university. Kristin arranged for Dr Kossick to contribute his expertise to this podcast while we were still in the program back in early 2015 and this episode was released as one of the original group of podcasts that launched From the Head of the Bed that year.
Dr Kossick will give a more detailed introduction of his professional background at the start of this show – and, I’m thrilled to have Kristin’s voice on the podcast with all her pre-Mainer southern drawl – as she introduces him. Dr Kossick was known as an incredibly challenging yet supportive professor. His area of expertise was intra-operative monitoring and the uptake and distribution of volatile anesthetics. He had a passion for the many beautiful curves of the science of anesthesia, whether it was the oxyhemoglobin dissociation curve, the Fa/Fi curve or one of the many other curves that define the science behind what we do every day. Kristin and I and so many other CRNAs from WCU, the University of Alabama at Birmingham and others have learned so much from Dr Kossick and consider ourselves fortunate to have sat in and survived his classes.
This is an incredibly thorough review of the very basics of EKG lead placement, selection and monitoring for anesthesia care. This is a skill and knowledge set that, unfortunately, many anesthesia providers and perioperative nursing staff overlook and blaze past. As Dr Kossick says in the show, simply having a EKG pattern on the screen from careless placement of EKG leads is not enough for safe monitoring. Dr Kossick walks us through the core data on EKG monitoring, including some modified leads, so this show is excellent for both trainees and experienced providers alike.
What up folks! This is another short podcast on the idea that safety is a capacity, not an outcome. This idea comes out of Todd Conklin & Sidney Dekker’s work on organizational safety where they discuss two ways of looking at safety:
The Safety 1 Perspective or the old way of thinking is that safety is about minimizing errors. It’s about identifying risks, including human behaviors, and implementing steps to prevent errors from happening. Success is often measured in low to zero error rates and errors are punishable offenses.
The Safety 2 Perspective doesn’t overlook the need to minimize errors. But it focuses on building the capacity for the right thing to happen versus a feverish focus on whack-a-moling potential risk and, frankly, whack-a-moling the people who make mistakes.
The idea is that safety is not an outcome but rather a capacity that’s built up over time through thoughtful design of systems and careful handling of people and systems both when things go right as well as when errors happen. It’s about figuring out how humans are doing the work – including all of their workarounds – in order to generate successful outcomes and finding ways to support and foster positive outcomes on a consistent basis. And when things go wrong, people aren’t punished. While egregious error or outright negligence is always possible, Safety 2 presumes people are smart and are trying to do the right thing. So if something goes wrong, there is likely a system input, factor or design that created a high probability that something would in fact go wrong. So the focus is on understanding how the worker performed in a faulty system and trying to improve that system so there’s a higher likelihood that the right thing happens the next time around.
Check out the short podcast for a couple of illuminating stories to bring these principles to life. As always, drop me an email or message on social media if you’d like to connect!
What up yall this is Jon Lowrance and this is episode 96 – virtual reality in anesthesia education: SIMVANA with Peter Stallo.
This show is coming out in early August of 2023.
First up: I want to give a quick heads up that our team from Maine Medical Center where I currently serve as chief CRNA will be at the American Association of Nurse Anesthesiology Annual Congress in a couple of weeks in Seattle. If you’re headed to AANA’s Annual Congress this year, be sure to swing by the exhibit hall and check out the MaineHealth booth. My friends & colleagues April Bourgoin, Cat Godfrey & Steve Breznyak will be there to tell you all about career opportunities at our level 1 trauma hospital, Maine Medical Center, and other MaineHealth hospitals. We have everything from independent, CRNA-only practices to a high acuity level 1 trauma center within MaineHealth, so if you’re interested in finding out more about what life looks like in the upper right hand corner pocket of the US, come chat with us! I believe Peter Stallo with SIMVANA – who we’re talking with today on the show – will also be at Annual Congress, so be sure to swing by and tell him you listened to this episode and see what SIMVANA is about in person!
This show is very interesting for a couple of reasons:
I’m stoked to talk with Peter Stallo. Peter created Prodigy Anesthesia back in 2004. This was probably the very first computer-based anesthesia educational & board preparation study tool. Kids these days can’t imagine getting through anesthesia training without programs like this. And Prodigy is what Kristin & I exclusively used to study for boards back in 2015… so I’m personally very grateful for Peter’s development of that program. (side note… I have no financial ties with Peter, Prodigy or SIMVANA to disclose… this just pure gratitude I’m working with here).
I’m also stoked about what we’re going to chat about. Virtual reality simulation will likely become a central aspect of anesthesia training in the future. As the technology becomes more widely available and the user experience further developed and refined, programs like SIMVANA will likely become ubiquitous… just like with Prodigy over the last 20 years.
I’m reminded of something Elon Musk stated in a documentary about SpaceX. Now, I don’t know how you feel about Twitter becoming X & how Elon is reshaping that organization or many of his other decisions. But I think we can agree on the fact that the man has created & lead some remarkable organizations built on tenacious visions of what’s possible for the future. In this documentary on SpaceX, Elon talked about how progress isn’t inevitable. Some people just assume that the future will be better… that space travel will become routine or that will we become a multi planetary species or that we’ll solve for global warming & climate change. But these things won’t actually happen unless individuals first imagine that they’re possible and then 2) put the work in to bring them into fruition. Elon is someone who has devoted himself into putting the work into creating paths to a better future.
Similarly, Peter Stallo is someone who didn’t stop progressing after he passed boards back in 2004. I always say that boards is an amazing finish line & culmination of years of preparation & hard work. We’re in that season again right now as anesthesia programs & residencies wrap up between May, June, July & August. It’s awesome to watch trainees make that transition from graduation into clinical practice. So while boards is a finish line of sorts, it’s also a starting line. It’s when the start gun goes off for the rest of your career. And back in 2004, just after Peter took boards, he got back to work. With 2 master’s degrees in healthcare behind him, he set about creating Prodigy Anesthesia. Then in 2014, he completed a Graduate Certificate in Orchestral Composition for Film and Games from Berkley College of Music… I didn’t even know there was just a thing. And in 2018, he began developing a virtual reality anesthesia training program which would eventually become SIMVANA. Peter picked up his third Master’s Degree – yes, his THIRD, in 2021 from the University of Alabama in healthcare simulation and is currently working towards completing a PhD in healthcare simulation from Massachusetts General Hospital Institute for Health Professions.
What’s remarkable, is that Peter’s career has spanned the timeframe from when anesthesia boards was a pen & paper exam, through his development of one of the leading digital board preparation programs and now into the first virtual reality anesthesia simulation program. Peter has embodied the very idea that Elon Musk talked about: progress isn’t inevitable. Having virtual reality as an available tool for anesthesia training – whether you’re in Cincinnati, Canberra or Cape Town – isn’t automatically going to be a thing. Someone’s got to put the time in. Or better yet, a team of someones, which Peter will talk about in this show.
Today I’m joined by John Fratianni who created the content for this episode as part of his Doctorate in Nurse Anesthesia Practice at Virginia Commonwealth University in Richmond, Virginia. John earned a Bachelor of Science in Nursing at the University of North Carolina at Chapel Hill, a Master of Science in Nursing at the University of Alaska Anchorage, and completed his critical care nursing training with the United States Air Force where he served 7 years on active duty. John conducted a study to determine if ChatGPT, an artificial intelligence (AI) program, can assist us in providing anesthesia care to our patients.
I want to give a special shout out to Peter Stallo who founded Prodigy Anesthesia and SIMVANA, both of which are digital educational tools for anesthesia trainees. Peter worked closely with John to grant access to Prodigy’s vast database of board-style anesthesia questions. If you haven’t checked out Prodigy or SIMVANA – which is a virtual reality based anesthesia education platform, links are in the show notes. I also want to personally thank Peter for creating a great board prep program in Prodigy… it’s all my wife and I and several of our classmates used to study for boards and we passed on the first try. Nice job, Peter and thank you!
Since this episode is part of John’s doctoral work with Virginia Commonwealth University, he kindly requests that you take a quick survey that’s embedded in the show notes. It’s 5 questions and will literally take you 30 seconds… click the link and give John & me some feedback on how we did with this.
In this episode, I speak with Dr April Bourgoin, DNAP, CRNA about operating room fires – how they can start and how we can respond to them as anesthesia providers. This show was originally released in 4 years ago in February of 2019 on the podcast From the Head of the Bed and was recorded with a table top microphone so the audio is a little suboptimal, but I’m sure you’ll still find this to be a very hot topic that will smolder in your memory for years to come after they key details become seared into your clinical practice. Hopefully, this podcast will really help you turn up the heat on your OR fire prevention practices… and now that we have almost all of the puns put out, let me tell you about Dr Bougoin.
Dr Bourgoin completed her Master of Nursing Science (MSN) and Doctorate of Nurse Anesthesia Practice at Virginia Commonwealth University. Prior to becoming a CRNA, she served for eight years as an active duty commissioned officer in the Army with experience as a critical care Registered Nurse and flight nurse with the 82nd Airborne Dustoff medevac team. She served two combat tours prior to transferring to the Army Reserves at the rank of Major and then returned to school for her master’s and doctorate degrees in anesthesia.
Dr Bourgoin had a case in which there was an OR fire and we discuss that story in detail in this podcast. She then unpacks OR and airway fires for us, including contributing factors, prevention, crisis management and the importance of critical incident debriefing.
Currently, I have the incredible privilege in working closely with April to support our CRNA group at Maine Medical Center in Portland, Maine. April is one of our 2 CRNA Supervisors and an invaluable part of our CRNA leadership team. I think you’re really going to enjoy hearing from her on this topic and in an upcoming episode on the pathophysiology of vaping associated lung injury.
In the show notes to this episode we have links to the Anesthesia Patient Safety Foundation’s infographics and video on OR fire prevention and safety, which are excellent resources to share with colleagues & classmates. We also link to a resource called Anesthesia eNonymous, which is a website hosted by faculty from Virginia Commonwealth University’s Nurse Anesthesia program where providers and anesthesia learners can anonymously share and read real stories of near misses, medical errors & other clinical experiences. As it’s been said: good judgment comes from bad judgment and it’s better to learn from others mistakes & bad judgement calls than having to make your own along the way. So be sure to check out the links in the show notes to this podcast that Dr Bourgoin has shared and with that, let’s get to the show!
Climate crisis is a growing global health problem, one which the field of anesthesia contributes to with its use of volatile anesthetic gases. This podcast is part of the doctoral project of Jacob Bonnema and it aims to increase knowledge and awareness of the environmental effects of volatile gases, particularly desflurane, to empower providers to plan environmentally-conscious anesthetics.
As of October 2022, Jacob Bonnema, BSN, RN, CCRN is a senior nurse anesthesia resident at NorthShore University HealthSystem School of Nurse Anesthesia in Chicago, IL. He has a passion for environmentalism and when it came to selecting a topic for his DNP project, wanted to choose a subject that would incorporate that interest.
Jacob is conducting a study associated with this podcast and we’re asking for your participation. Please click the link below to take the pre-survey, then listen to show and follow the same link below to take the post survey.
Jacob has made this incredibly easy by imbedding the audio for the podcast directly between the 2 surveys at the link below. Just click the link and you’ll see the pre-survey, then the audio content and then the post-survey all at Jacob’s site… super easy!
You can also listen to the audio at Anesthesia Guidebook or wherever you listen to podcasts!
Here’s 2 reasons you should do these super quick surveys: the most important is that it will help you learn the content better and make this show stick in your incredibly powerful brain. By testing your knowledge up front, then listening to the content, the retesting to see what you picked up in the show, you will increase your ability to recall this information so you sound really smart when talking about it with your colleagues & students at work.
And the second reason is that by completing this survey you can feel good about yourself because you’re contributing to science. The more people who complete the pre & post surveys, the better data Jacob will have. And that makes you and Jacob happy. And me. We’ll both be stoked if you pause the podcast now and hit the pre & post surveys.
All right, with that, let’s get to the show…
(References available upon request; Jacob’s contact information is available through the survey link.)
What’s up y’all this is Jon Lowrance and this is episode 89 – Distraction in the OR with Heather Turcotte, DO. Y’all, I am so stoked to bring you this conversation… I caught up with Dr Turcotte earlier this summer as she was finishing her residency in anesthesia and I’m pumped to finally get this out to you in early September of 2022. This topic was the focus of her residency project and senior grand rounds presentation and it definitely created a stir in our group as CRNAs, physicians, residents & SRNAs grappled with how to appropriately use cell phones and other technology in their practices.
Since it’s late summer, early fall… I gotta give a shout out to all the residents & SRNAs out there who graduated this summer. It’s always fun to see yall wrap up clinicals & residency projects and transition into your new jobs or fellowships.
I love getting texts & photos from SRNAs of their board results with the word PASS printed in the middle of the page… It’s such an incredible moment that makes all of the hard work worth it. So thanks to all of you who have reached out by email, text & social media recently with your passing boards photos, positive reviews & ratings of the podcasts and questions. This podcast puts me in touch with so many amazing people… I’ve recently heard from experienced providers to newly minted CRNAs on the day they pass boards, to brand new CA1’s to ICU nurses who found the podcast and are on the path to becoming anesthesia providers. Wherever you are in your own journey, my hope is that Anesthesia Guidebook will be a go-to guide for you as you seek to get your learn on and master your craft.
Heather Turcotte, DO joins me in this is fascinating conversation that weaves through the considerations around using cell phones in the OR, checking email/internet, music that’s playing, conversations, door swings and other forms of distraction in the operating room.
Dr Turcotte was born and raised in the great state of Maine. She earned a doctorate in physical therapy and practiced as a physical therapist for 4 years before going back to medical school in 2014 at the University of New England. Dr Turcotte finished her residency in anesthesiology at Maine Medical Center in 2022 and entered into private practice. Outside of medicine, she enjoys spending time with her husband and 3 kids, who are 9, 6, and 1 years old at the time of this recording, going to the beach, and drinking lots of coffee!
In this conversation, Dr Turcotte brings this discussion to life with a case study where an anesthesia provider settled out of court in a dispute on negligence in a case where the patient experienced hypotension and a PEA arrest, survived the case but died a few days later. The anesthesia provider had used their cell phone and anesthesia station computer to check email and online news stories. Interestingly, an expert anesthesia witness testified that the actions of the anesthesia provider in managing the patient were flawless. But just because the provider had used their cell phone & surfed the internet on the work computer, the legal team advised they settle to avoid a jury verdict on the case.
Cell phone use, open internet access including email, music playing the OR and so many other forms of distraction are common elements in operating rooms across the United States. Some institutions create policies that limit cell phone use in the OR. Others have policies that are more vague while others have no formal policies around cell phone use in the OR. There’s legitimate considerations for each of these… On one hand, how does a hospital enforce a policy that is very strict? Does creating a policy set that institution up for compliance issues or litigation? On the other hand, how can hospitals help engineer safe and reliable environments for providers to work in? As technology continues to become more and more central t0 the work we do, the issues of attention span, distraction, user experience of technology and systems engineering to create & maintain safe environments will remain important factors for each provider, group and institution to consider.
What’s up yall this is Jon Lowrance with Anesthesia Guidebook. I am so pumped to bring you this series of 3 episodes on Combat Trauma Anesthesia!
This is episode 87 and it’s part 2 off a three-part series with Dustin Degman, a CRNA formerly with the United States Army.
In the first episode, we discussed Dustin’s experience in Afghanistan serving at a forward operating base in Paktika Province in 2012 to 2013. We talk about what makes up forward surgical teams and the role of CRNAs as the sole anesthesia provider on these teams.
In this part – part two, we discuss the principles of damage control resuscitation in the context of forward surgical bases and combat zones. While this discussion is focused on combat trauma anesthesia, the core underlying principles of damage control resuscitation hold true for civilian trauma centers.
And then in part three, we’re gonna come back and talk about the path to becoming a military CRNA and the importance of supporting our troops.
This series was originally recorded in early 2015, just a year or so after Dustin had returned from Afghanistan and while the war there was still raging. At the time, I was completing my anesthesia training at Western Carolina University and working on launching From the Head of the Bed… the podcast the preceded Anesthesia Guidebook. Dustin was one of my professors and clinical faculty at WCU and was kind enough to volunteer his time for these interviews back then. The reason I’m bringing them forward here is that they’re chock full of wildly fantastic details on the experience of a forward-deployed military anesthesia provider and the principles of trauma anesthesia, which are absolutely relevant today.
Dustin served with the Unites States Air Force from 1998 – 2002 as a critical care Registered Nurse. He was honorably discharged and went on to complete his anesthesia training outside of the military. In 2010, he re-enlisted with the Army Reserves as a CRNA and was deployed in November 2012 to Forward Operating Base Orgun-E in Paktika Province, Afghanistan where he was the sole anesthesia provider on a forward surgical team providing damage control resuscitation to injured soldiers. Most recently, Dustin serves as the chief CRNA at PeaceHealth’s Peace Harbor Medical Center in Florence, Oregon. In 2021, Dustin was awarded the PeaceHealth Mission & Values award and the organization put together an incredible video tribute to Dustin. Degman is the real deal… he was the real deal a decade ago when he was serving in Paktika Province, Afghanistan, which he talks about in these next 3 episodes and he’s still the real deal as he serves as a CRNA with Peace Harbor Medical Center out on the coast of Oregon.
I think you’re going to really enjoy hearing from Dustin on combat trauma anesthesia and with that, let’s get to the show!
To close each of these 3 episodes out, I’d like to encourage you to make a donation to the Pat Tillman Foundation in honor of Army Ranger Pat Tillman who was killed in Afghanistan in 2004. The Pat Tillman Foundation awards academic scholarships to military service members, veterans and their spouses. Dustin Degman identified this as one of the several service organizations that he believes in and encourages you to give to either the Pat Tillman Foundation or an organization you connect with. If we each give $10-20, our collective impacts will make a huge difference.
Jenny Finnell, MSN, CRNA joins me to talk about how anesthesia trainees can master the didactic phase of their training. We cover lots of tips in this show: everything from how to make challenging content stick to how to get organized, which apps & resources are helpful and how to maintain mental wellbeing during anesthesia training.
This episode will help you dial in your plan for success in didactics. Our goal is for you to thrive and not just survive in school. The volume of information you have to master is immense and the learning curve is incredibly steep, especially when you begin to integrate clinical training into your journey. Creating early success in didactics is key to progressing in anesthesia school.
There’s 3 domains of knowledge in any kind of training:
the know-what
the know-why and
the know-how.
The know-what is the core information, principles & facts.
The know-why is understanding the situationally-specific rationales for actions & processes.
And the know-how is where we learn to put the know-what & the know-why into practice: it’s the experiential, practical application of knowledge.
The didactic portion of training is where we pick up most of the know-what. What you need to know is learned by studying, being taught, reading, watching video & listening to lectures & podcasts. It’s here where we also learn a lot of the know-why: the rationales behind why we do things the way we do them in anesthesia. You’re only able to develop the art of anesthesia if you have a solid foundation in the science of anesthesia. Learning the know-how: the actual mechanics and flow of putting everything together, the timing & art of anesthesia is learned best by doing… especially when that experiential education is under the guidance of a skilled preceptor, clinical coach or mentor.
Jenny Finnell, MSN, CRNA runs the CRNA School Prep Academy, which is a mentoring and professional coaching community designed for those who want to pursue a career as a CRNA. Her team offers a blog, podcast and public & private forums as well as individualized coaching for every phase of preparing for anesthesia training. She’s active on Facebook & Instagram if you want to see what the CRNA School Prep Academy is all about or you can certainly cruise over to her website at CRNAschoolprepacademy.com.
…this is Jenny Finnell’s Six-Page Free Resource Guide. In it, she lists the best podcasts, YouTube channels, apps, websites, books related to anesthesia, studying/learning, grad school interviews and professional resources.
Vargo Anesthesia Mega App. This is an incredibly thorough app covering run downs on surgeries, pathological conditions, pharmacology and detailed weight-based guides to pediatric anesthesia. While you have to pay for this app, the cost is definitely worth what you get.
Master Anesthesia app in App Store: check out the story from app creator Matthew Willis in Episode 38 of Anesthesia Guidebook. This app is FREE and growing in its scope of surgeries & medications but rolled out with a phenomenal calculator for quickly seeing max doses of multiple local anesthetics.
Writing in the Sciences: FREE course on professional/scientific writing from Stanford University. Take this course to improve your professional writing.
This is part 2 of my conversation with Mason McDowell, DNAP, CRNA. In 2014, he, along with his wife and 2 young daughters, sold everything they owned and moved full time to the heart of Africa… to the town of Beré in the nation of Chad, to provide anesthesia services at hospital with severe resource limitations.
Dr McDowell was a professor of mine and the assistant program director at Western Carolina University when he made the decision to move to Chad. I remember him preparing and talking about the why behind his decision and watching that process unfold was incredibly powerful.
In part one of our conversation (episode 61), Mason talks about the decision to go to Chad, what he and his family did there and why they had to evacuate the country emergently and return to the United States. In this episode, Mason shares advice for those who wish to travel and provide anesthesia for underdeveloped, impoverished and/or remote communities.
The stories Mason shares in this 2-part series are remarkable but they only scratch the surface of his time in Chad. I’ll link to his blog at whyweshouldgo.blogspot.com in the show notes where you can read about the day-to-day, night-to-night tales from providing anesthesia and general medical services in Chad. THOSE stories are heart wrenching. There we innumerable times when Mason and his team had to make decisions based on the severe resource limitation that we simply would never have to make here in the United States. I’d like to share one of Mason’s stories with you here:
4-3-2-1 8 Dec 2014, Bere, Chad by Mason McDowell, DNAP, CRNA
I was called out of our morning meeting at the hospital
around 730am with the wave of a hand. I knew what it was even before I asked for confirmation: Bébé? Oui.
A mother had just delivered twins but baby #2 wasn’t breathing. I gave oxygen, breathed for him with an ambu bag and tried to keep him warm. Danae (the OB/GYN) lifted her scrub shirt to press baby against her skin to warm him as I continued to hand ventilate. Eventually he was breathing on his own and was sent to our “NICU”– that’s the neonatal intensive care unit; except in Chad it means he is getting oxygen while he rests in a tiny cardboard box in our OR with 2 hot water bottles tucked beside him. Guess what? He’s still alive tonight!
Flash forward to around 8pm when our volunteers arrived from the US. They were only here 10 minutes before an urgent phone call: maternity…a mom turned quickly…send Mason now! I threw on scrubs and my friend Shawn (also an anesthetist) hurried along behind me.
We arrived to find a seemingly dead looking pregnant woman laying on the floor and frothing at the mouth. We moved her quickly down the sidewalk to the OR and began CPR. Chest compressions, oxygen/ventilation, IV epinephrine…Nothing. Now thats a terrible situation–lifeless and pregnant. I told Danae “she’s dead-dead …get the baby out”.
I barely finished the sentence before Danae cut down and retrieved a baby girl. Good pulse but not breathing. After an extended period of manual ventilation and stimulation the baby perked up and breathed on her own! The unmistakeable scent of Arabic perfume lingered in the air as it radiated from the cloth I used to wrap the baby in. The fabric had been part of her mothers clothing. Blood covered the OR table, floor, and the surgeon. We cleaned up the baby’s mother and brought in the family for a final viewing. Tears and prayer filled the OR. The family left to find a truck to carry the body away and I walked home alone under a brilliant night sky, still replaying the events of the day and looking for lessons to learn.
I returned home to find suitcases filled with treasures from the US. Our friends brought items purchased or donated for us and our hospital– it was like an early Christmas. After 30minutes of sorting goodies and eating junk food another call came: stat C-section. Seriously?!
A very young mother with complicated labor was already in preop when I arrived. Unfortunately the dead body from an hour ago was still in the OR (still waiting for family) and we had to find a way to move it out and bring in the new patient without making a big scene. If it wasn’t so sad it would have been comical. We pushed the dead woman into our tiny preop room after angling the new patient’s stretcher in a way that she had to twist around to see the body. And that’s exactly what she tried to do. We built a human wall with the 4 of us as we shuffled along pulling the new patient past the body (just 2 feet away).
Now in the OR: IV fluid, monitors, spinal anesthetic administered easily–cut down and baby retrieved in textbook fashion. Except…Silent baby. Floppy baby. Apneic baby. After stimulating, warming, and ventilating with oxygen…nothing. Pulse rate 160:perfect. But he’s not breathing.
Ventilate. Stimulate. Spank…again and again. The sound of surgery continued behind me. NDilbe attended to the mother as I worked on the baby boy. After maybe 40 minutes that baby boy had a perfect heart rate, perfect color, perfect body temperature… but he wouldn’t breath. Not even a sputter. I told Danae I was stopping. We have no ventilator here and no other option. Chad is harsh. Only the strongest survive. I kept my hand draped over his chest and I stroked his hair as I felt the warmth of his body slip away while I whispered words of prayer. It think it took about 10 minutes to see his heart rate slow and then finally stop. I stayed with him and I finally glanced over my shoulder at his young momma: She knew. She saw my eyes and heard the silence. It took 10 minutes to watch a baby die once I quit breathing for him. How long will it take to forget this day?
4 resuscitations
3 babies in peril
2 babies beat the odds
1 husband/father/friend who is beyond thankful for faith and daily blessings. Life is good even when it’s hard.
-Mason
A young patient assess Mason McDowell, DNAP, CRNA.
You can find that and so many other stories in Mason’s writing.
Mason and his family moved to Chad with the intention of living there for years. Unfortunately, a couple of years into their new journey, the political and security situation deteriorated rapidly in Chad and the US State Department issued a warning that all US Citizens should evacuate immediately. Mason talks about the decision to leave with a day’s notice and the culture shock he and his family experienced upon their return to the US. Not long after that, in May of 2017, I caught up with him to record these interviews.
This podcast and the one to follow are pure gems. You’re gonna hear from Dr. Mason McDowell who in 2014, sold everything he, his wife and 2 young daughters owned and moved full time to the heart of Africa… to the town of Beré in the nation of Chad to provide anesthesia services at hospital with severe resource limitations.
Dr McDowell was a professor of mine and the assistant program director at Western Carolina University when he made the decision to move to Chad. I remember him preparing and talking about the why behind his decision and watching that process unfold was incredibly powerful. He’ll talk a little about that in this show.
I just want to frame how massive of a change this was for Dr McDowell and his family. They lived in a planned community of beautiful residential homes and businesses nestled in the mountains of Asheville, North Carolina. The community housed a satellite campus for WCU and our anesthesia program. Mason could walk to work from his home, step across the street to a number of stellar restaurants or high end shops or even stroll to the end of the block to the grand movie theater to watch a show with some fresh popcorn. He was well-respected in the local community and maintained an anesthesia practice at the local 800-bed trauma center with all the technology and resources you could imagine. And they decided to leave all of that and move full time to Bere, Chad. The hospital where Mason went to work didn’t have a functional anesthesia machine. Mason flew to Europe to buy a draw-over vaporizer so that he could bring inhalational anesthesia to the Bere. Before Mason and that machine showed up, the options were either ketamine or spinals. That’s it.
The stories Mason shares here are remarkable but they only scratch the surface of his time in Chad. I’ll link to his blog at whyweshouldgo.blogspot.com in the show notes where you can read about the day-to-day, night-to-night tales from providing anesthesia and general medical services in Chad. THOSE stories are heart wrenching. There we innumerable times when Mason and his team had to make decisions based on the severe resource limitation that we simply would never have to make here in the United States. I’d like to share one of Mason’s stories with you here:
4-3-2-1 8 Dec 2014, Bere, Chad by Mason McDowell, DNAP, CRNA
I was called out of our morning meeting at the hospital
around 730am with the wave of a hand. I knew what it was even before I asked for confirmation: Bébé? Oui.
A mother had just delivered twins but baby #2 wasn’t breathing. I gave oxygen, breathed for him with an ambu bag and tried to keep him warm. Danae (the OB/GYN) lifted her scrub shirt to press baby against her skin to warm him as I continued to hand ventilate. Eventually he was breathing on his own and was sent to our “NICU”– that’s the neonatal intensive care unit; except in Chad it means he is getting oxygen while he rests in a tiny cardboard box in our OR with 2 hot water bottles tucked beside him. Guess what? He’s still alive tonight!
Flash forward to around 8pm when our volunteers arrived from the US. They were only here 10 minutes before an urgent phone call: maternity…a mom turned quickly…send Mason now! I threw on scrubs and my friend Shawn (also an anesthetist) hurried along behind me.
We arrived to find a seemingly dead looking pregnant woman laying on the floor and frothing at the mouth. We moved her quickly down the sidewalk to the OR and began CPR. Chest compressions, oxygen/ventilation, IV epinephrine…Nothing. Now thats a terrible situation–lifeless and pregnant. I told Danae “she’s dead-dead …get the baby out”.
I barely finished the sentence before Danae cut down and retrieved a baby girl. Good pulse but not breathing. After an extended period of manual ventilation and stimulation the baby perked up and breathed on her own! The unmistakeable scent of Arabic perfume lingered in the air as it radiated from the cloth I used to wrap the baby in. The fabric had been part of her mothers clothing. Blood covered the OR table, floor, and the surgeon. We cleaned up the baby’s mother and brought in the family for a final viewing. Tears and prayer filled the OR. The family left to find a truck to carry the body away and I walked home alone under a brilliant night sky, still replaying the events of the day and looking for lessons to learn.
I returned home to find suitcases filled with treasures from the US. Our friends brought items purchased or donated for us and our hospital– it was like an early Christmas. After 30minutes of sorting goodies and eating junk food another call came: stat C-section. Seriously?!
A very young mother with complicated labor was already in preop when I arrived. Unfortunately the dead body from an hour ago was still in the OR (still waiting for family) and we had to find a way to move it out and bring in the new patient without making a big scene. If it wasn’t so sad it would have been comical. We pushed the dead woman into our tiny preop room after angling the new patient’s stretcher in a way that she had to twist around to see the body. And that’s exactly what she tried to do. We built a human wall with the 4 of us as we shuffled along pulling the new patient past the body (just 2 feet away).
Now in the OR: IV fluid, monitors, spinal anesthetic administered easily–cut down and baby retrieved in textbook fashion. Except…Silent baby. Floppy baby. Apneic baby. After stimulating, warming, and ventilating with oxygen…nothing. Pulse rate 160:perfect. But he’s not breathing.
Ventilate. Stimulate. Spank…again and again. The sound of surgery continued behind me. NDilbe attended to the mother as I worked on the baby boy. After maybe 40 minutes that baby boy had a perfect heart rate, perfect color, perfect body temperature… but he wouldn’t breath. Not even a sputter. I told Danae I was stopping. We have no ventilator here and no other option. Chad is harsh. Only the strongest survive. I kept my hand draped over his chest and I stroked his hair as I felt the warmth of his body slip away while I whispered words of prayer. It think it took about 10 minutes to see his heart rate slow and then finally stop. I stayed with him and I finally glanced over my shoulder at his young momma: She knew. She saw my eyes and heard the silence. It took 10 minutes to watch a baby die once I quit breathing for him. How long will it take to forget this day?
4 resuscitations
3 babies in peril
2 babies beat the odds
1 husband/father/friend who is beyond thankful for faith and daily blessings. Life is good even when it’s hard.
-Mason
A young patient assess Mason McDowell, DNAP, CRNA.
You can find that and so many other stories in Mason’s writing.
Mason and his family moved to Chad with the intention of living there for years. Unfortunately, a couple of years into their new journey, the political and security situation deteriorated rapidly in Chad and the US State Department issued a warning that all US Citizens should evacuate immediately. Mason talks about the decision to leave with a day’s notice and the culture shock he and his family experienced upon their return to the US. Not long after that, in May of 2017, I caught up with him to record these interviews. I apologize up front about the audio. At the time I was using a desk top microphone that captured everything in the room and the acoustics were not ideal. But I guess these shows are about doing anesthesia in non-ideal environments so if you’ve made it this far, I bet you’ll cope with the audio just fine.
In this first episode you’ll hear about Mason and his family’s decision to go, what it was like, what they did there and why they had to leave. In the next episode, Mason shares advice for other anesthesia providers who are interested in short or long term mission work.
In this episode, which was originally released in April of 2019 on From the Head of the Bed… a podcast for the anesthesia community, Ashley provides an incredibly detailed run down of the anesthesia machine: the flow of gas through the machine, high, intermediate and low pressure system components in the machine, variable bypass vaporizer structure & function, relevant gas laws, safety systems & features and more! If you’re an anesthesia learner just hitting the ORs, this show will give you a detailed run down on what you need to know to use the anesthesia machine. If you’re a seasoned provider and clinical educator/preceptor, this show provides a wonderful reminder of core information on the machine so you can best support your learners.
Ashley Scheil earned her BSN from Purdue University in 2012. She worked as a critical care Registered Nurse in the surgical ICU at the Roudebush VA Medical Center in Indianapolis for 6 years before going back to anesthesia school to earn her DNP at Marian University in May of 2020. Dr Scheil, DNP, CRNA practices at IU Health Arnett Hospital as of September 2021.
Resources
E – Cylinder Calculation
Amount of oxygen in cylinder in liters divided by liters of flow:
At full pressure (1900 PSI): 660 liters / 3 lpm = 220 minutes of O2.
At half pressure (950 PSI): 330 liters / 10 lpm = 33 minutes of O2.
Butterworth, J. F., Mackey, D. C., & Wasnick, J. D. (2018). Morgan and Mikhail’s clinical anesthesiology. McGraw-Hill Education.
Miller, R. D. (2014). Miller’s anesthesia. Philadelphia, PA: Elsevier.
Nagelhout, J. J., Elisha, S., & Plaus, K. (2017). Nurse anesthesia. Elsevier Health Sciences.
