The End of First Year Rotations

The time has finally come to put the “Junior SRNA” title away and pick up the new “Senior SRNA” moniker. Starting this coming Thursday our class will have officially started our senior class rotations and the specialties that go with it. The monthly rotations will start September 1st and change with each coming month for the next year. Of course there will be some rotations that last two months, specifically pediatrics, but each month on the first we all will be shifting gears and on to a new experience.

For me, I will be starting the cardiac surgery rotation at Los Angeles County Hospital. This is a shared experience with the MD resident. Fortunately for me I will be with my good friend AJ who has shown me so much in the past. AJ is a 3rd year anesthesia Resident at the USC Keck School of Medicine program and was there when I started my clinical experience at LAC-USC Hospital.

The way it works is that we share the cases alternating each day who puts in the lines while the other person does the airway management and takes credit for the case. We can not both take credit for the case for certification purposes but the learning goes on anyway. In this way we both get the most out of the experience and for me this is totally acceptable. I will be finishing up my general surgery rotation at Arrowhead Regional Medical Center in Riverside tomorrow and AJ will do the preoperative evaluation for me so that I do not have to travel after a long day in the OR and then do the preop at another hospital for the next day. That is a relief.

David and two Texas Weslean Students at Arrowhead Regional Medical Center

Finishing Up at Arrowhead Regional Medical Center

Being at Arrowhead Regional has been a really great experience. This past month the schedule has been really good for me. In the morning a Whipple procedure is scheduled for my room. This will be the second Whipple for pancreatic cancer that I have done in the past two weeks. These are really big surgeries with the necessity for central line placement and central venous pressure measurement, arterial line placement before induction and two large bore IV’s for access. In addition I will be placing an epidural catheter for post operative pain management. All of this requires extra time so after discussing these plans with the MD attending staff this afternoon the patient will be in the preoperative holding area at 6 AM for the line placement. At least I will get the epidural and arterial lines in and after this gentleman is asleep we will get the central line secured.

David behind the Blood-Brain-Barrier during a hand surgery case

Looking back over the past year and seeing the growth that has taken place is easy today when I think about this Whipple case and how I am comfortable with the issues in the anesthesia management for this surgery. A year ago just getting a patient asleep was a major big deal. So it’s good to review how far we have come and to reflect on what is yet ahead to learn and grown in. This coming year of specialty rotations is bound to be extremely challenging and rewarding in all that we will learn. I am so much looking forward to all of it, the hard work and the satisfaction of knowing that we all have done a great job taking care of our patients when they are the most vulnerable.