Red Blanket?…..What's a Red Blanket?


Recalling with fondness the distant past when super-hero’s roamed the earth and The Green Hornet series was still in vogue, I remember The Shadow.  No, not the sinister menace that waited for little boys and girls around every dark corner on cold windy nights.  This Shadow is the one that introduces a new and exciting path for those that seek it.  Recently we have had many requests for “shadow” experience here at the Big County and the nurse anesthesia program.  We try to accommodate.

The Shadow4The best months to set up a “Shadow” day to follow a nurse anesthetist is now – between the months of September and January.  These are the months when our first year students are busy in the classroom and the clinical staff in the operating rooms are free to turn their attention to potential candidates entering the program of nurse anesthesia.  We do allow candidates to shadow all year long but the days are more restrictive.

Recently a persistent young man was able to come by and was shown around our dearly loved County Hospital.  It was a busy day.  Maybe that is for the best because it gave a realistic picture of whats its like to have a clinical practice in a large public hospital.  My kinda place.  What follows is the beginning of a screenplay I am sure.  The names have been changed to protect the innocent but the gist of the story is all factual.

Enjoy and let me know what you think.

Red Blanket?…What’s a Red Blanket?

By Hugh Adair

I met David at the double doors of the hospital entrance on the second floor. 6:30 sharp. The introduction was brief and to the point. “We need to get you into scrubs,” he said. Scrubs…awesome. I couldn’t believe this was actually happening.  I was so excited. I came across David’s blog Nurse Anesthetist, several months ago as I was scouring the web trying to find as much information as I could about CRNA’s.  At 35, I decided the life of a television producer was no longer going to fit. For 13 years, I worked in post-production for network and cable television. As a husband and relatively new father of two (a 3 year old son and a 1 year old daughter) I realized the 15-hour day, 6-day workweek was not going to work, plus I yearned to do something rewarding. A strong desire to help others drew me to my decision to become a nurse. I had always been interested in medicine – surgery specifically. When I found out there were nurses that provided anesthesia to patients in surgery, it seemed like a perfect match. Nursing and Surgery. After reading through David’s blog about his life as a CRNA and the journey that got him there, I was even more intrigued. I wanted to speak with him and ask him questions.

One particular page that leaped out at me was an entry on the importance of a shadow day. A shadow day is when a prospective student follows a CRNA from case to case. As a shadow, you are observing right alongside the anesthetist as he or she is working. Having an opportunity to shadow a CRNA for the day would be a good test to see if this was something I was truly interested in pursuing. I reached out. I sent David an email explaining who I was and that I was interested in talking with him about being an anesthetist. I wanted to ask questions like, am I too old to do this? What are the career prospects and opportunities? I also asked if it would be possible to shadow him for the day. I sent the email. I never heard back. I was bummed.  I moved on. I searched the web looking for other possible shadow opportunities. I contacted local hospitals that employ CRNAs to see if they offer a shadow experience, I even asked an OB/GYN friend if she could help, she tried with no luck. Every request was a no. How was I to know if I would enjoy being a CRNA if I couldn’t get a chance to see what it was like? What if I were to invest all of my time, effort and tuition (not to mention the personal toll on my family) to go through nursing school, work for two to three years in ICU and then go back to school for 2 ½ additional years to finally become a CRNA – only to find out it was not for me? I needed confirmation.

Months had passed and I had almost forgotten that I had even sent an email. Then I got the word. David emailed me that his blog had been attacked by a virus and that he was sorry it took him so long to respond. He told me to call him anytime. I was ecstatic. I phoned immediately and left a message. After several rounds of phone tag over a couple of weeks (I didn’t want to hound the guy), we were able to connect. After our conversation that was kind of like a phone interview (I was quite nervous), David spoke the words that sounded like music to my ears. “Well, you need to come down and have a shadow day.” Really? Was this really what I was hearing? “How is your schedule?” he asked. The conversation ended and I met him two days later.

After a brief introduction to the incoming fall class of SRNAs and other faculty members, I was given a set of scrubs and we were off and running.

David was covering one of the operating rooms reserved for the E.R. Since these rooms are used specifically for the E.R., there were no scheduled procedures on the board.  By 7:00 am we were sent in to relieve two Resident Anesthesiologists who had been in surgery since 10:00 pm the night before. An 18-year-old male with multiple gunshot wounds to the pelvic region. When David took over, the Orthopedic team was finishing up their work and the OR staff were preparing for the Vascular team to begin their work of repairing this kid’s veins. After the exiting residents briefed David, he signed on and took over the case. David immediately begins assessing the patient, monitors and medications. David works at a rapid, yet controlled and calculated pace. Impressive. Very impressive. The patient is stable and very lucky to be alive as he lies on the table with an incision from his sternum to his lower abdomen, an incision from his inner groin to his knee and several incisions on his hip. The operating room buzzes with adrenalin. David continually monitors and adjusts his medications. He gives me a complete play-by-play of what he is doing and the reason why he is doing it. David even throws out a couple of test questions as any good teacher would. “This is an applied science,” he says. “Anyone can regurgitate information, that’s not good enough. You need to be able to practice it.” This is life or death. No room for errors.

It’s 9:00 am. Time is flying by and I am loving every minute of this experience. David needs to be relieved from this case to take over the room next door. He briefs the Doctor taking over the case. Once finished, David grabs his MP3 player and we move next door. David plugs in his music player and begins prepping for what is coming down the pike. David’s preparation is articulate and precise. Remember, no room for fuck-ups. David checks, double checks and triple checks his medications.  Once satisfied and set-up we take a quick break for a burrito. “You eat when you can,” he says. During our brief breakfast David asks if I’m still interested in pursuing the career. “Very much,” I replied. David, under no uncertain terms, makes it very clear how hard a road it is to become a CRNA. Preparation seems to be a paramount prerequisite for anyone considering applying to the USC CRNA program. In addition to courses taken during nursing school, David recommends taking additional semesters of physics, upper division chemistry and an epidemiology course. Breakfast was brief. We head back upstairs.

A 17-year-old male came in the night before with a clean fracture to both the ulna and radius. David showed me the x-ray on the computer screen. “This could be very complicated,” said David. Hardware was probably going to be needed. The boy’s mother passes by the nursing station as they wheel the patient into the pre-op room. She is visibly shaken and scared for her son’s pending operation. Her English is broken. David speaks to her in Spanish. Her eyes fill with tears. David’s words comfort her. She tells David she will pray for God’s guiding hand over him and the operating staff. I get a little choked up myself. This is real. This is exactly why I want to do this.

I follow David into the room for the pre-operative interview. The patient seems alert and lucid. David asks him how he ended up in the ER. “Skateboarding.” he said. David runs through a battery of questions. “Have you had any kind of surgery before? Any known allergies? Was he born naturally or by caesarian?” The mother had a natural birth, but premature. This was important information. David was writing down his notes when a nurse came in and said they were sending up a RB from the 6th floor. “RB? What’s an RB?”  “Red Blanket,” said David. A Red Blanket is an emergency call for surgery. An RB is a life or death call that apparently supersedes any scheduled or lower acuity procedure. David apologizes to the fracture case and tells them he will be back later.

A 55-year old female was six days out from colorectal surgery. On rounds, a resident was examining the patient and asked her to cough. The patient coughed, her abdominal sutures break and her intestines herniate. Surgery is definitely needed.  After reviewing her chart, David preps his workspace. David works expediently, yet remains cool. The OR is prepping. He turns on his music. David has an eclectic taste in his tunes, mostly British pop. I wondered if his music choices held any significance or if it was just white noise while he worked. The patient arrives, distressed. As described, a small portion of her intestines are protruding out of her stomach. The patient’s gut is severely swollen (gas). She looks like she is nine months pregnant. David reassures her and givers her something to calm her down. The patient begins to relax. As the team transfers her to the table, the patient loses control of her bowels and makes quite a mess. A slight distraction. The nursing staff make quick work and move on. David introduces another medication and the patient quickly falls asleep. Once asleep, the patient is intubated and put on the ventilator. By the way, if I haven’t mentioned this in a while, this experience is incredible. I am mesmerized, like a kid in a candy store. But I digress. The attending surgeon arrives. He and the resident get to work. It seems the patient’s fascia was not strong enough to hold the sutures. Before long, the patient is made whole and the surgery is over. I follow David as he escorts the patient to recovery. Once in recovery, David gives the post-op nurse a run-down from the surgery and follow-up orders.  This case is finished.

David makes tracks to prepare for the 17-year old with the fracture. I follow. David stops and tells me I need to go eat. My day in the OR was over. I was bummed. I was hoping he would say, “Ok, let’s go”, but I was done. Then I realized that it must be tiring having someone looking over your shoulder for six hours.  I thanked him once again and changed out of my scrubs.

David escorted me to the door where I met him. He told me once I was actually in nursing school that I should call and do it again. He was very gracious. We shook hands and he went back inside. What an experience. Thank you David.

There you have it straight from the horses mouth.  I think Hugh should stick to writing screenplays what do you think.  Just kidding.

Just so its clear, what Hugh did not notice is the communication and team work in the anesthesia department at the Big House.  We work in a team setting with M.D. anesthesiology and CRNA’s.  This is one of the great benefits for our patients.  Without being political, two heads and four hands are often better than one.  Get it?

Categories : Student Life


  1. melissa says:

    Thanks for sharing your experience. This is awesome!
    I’m working on my CCRN and GRE.
    The more I hear about it the more enthused I become!
    I find it so enticing to have all these different difficult cases come about and working on helping people recuperate from the situations they are in.
    Thanks for sharing because reading your experience motivates me to keep on studying, learning and working hard.

  2. David says:

    That’s what its all about.

  3. Nick says:

    It sounds like your shadower has the attention for detail it takes to be a CRNA. He certainly seems to have a lot of determination to make such an abrupt career change at 35!


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