It’s been about 70 days since the quarantine happened. The virus has come, peaked and stole thousands of lives, and left. But not for long, we will soon see the second wave.
Last week, a man by the name of George Floyd was brutally murdered by a knee hold by a member of the Minnesota Police Department. It’s so scary to think that not much of history has changed. The governor has implemented an 11pm curfew that changed to 8pm -5am for a week long. There have been protests everywhere, the looting that has started where people believe have been planted by the government as part of a distraction technique to pull away from the real attention to the problem — years and years of systemic racism and police brutality stemming from years of slavery. It’s sad because I still see it in the workplace, being judged based on the color of my skin and my gender. When will it end? Or is the world meant to be an evil place?
To think that not much has changed since Nazi Germany — where one person was able to get away with the killing of an entire race through ethnic cleansing via a fascist regime. History is just repeating itself. We need more education on how to create this change rather than learning about history in textbooks.
WE NEED CHANGE NOW!
My head is pounding. The lack of sleep overpowering my mind. The thought of returning back to the COVID ICU for only my 3rd shift, after being deployed from the main OR, is overbearing. You cannot imagine what one shift in the ICU can do to your morale… you know during school it’s like the toughest of a tough place you can imagine to be. As a nurse, as a provider, as a patient. The learning curve is so high that it takes years to understand pressor requirements, ventilator settings, what the numbers mean and if “the bump of creatinine” means something promising or not. The different pathways one lab value can take you into an abyss of things that would essentially either prolong the course of eventual death or suffering.
There’s an anti-LGBT organization called Samaritan’s Purse that have parked outside of Sinai to accommodate the surge of patients being admitted. All public areas all around NYC have been designated to be extra hospital beds. A naval ship has docked to take non-COVID patients. THIS SHIT IS GETTING REAL. Nobody knows how to handle this virus. We think we do but we have no idea. We are officially in a recession and unemployment is supposed to reach rates up to 15%. We are all the same. We are all suffering. We will all suffer from this. I just can’t wrap my mind around. I really can’t.
The bridge of my nose is developing a deep tissue injury from the N-95 mask I’ve work all day. Two more days and then some PTO that I will hopefully survive through.
I cannot believe how long it’s been since I wrote here. I gotta say… this one is for the books. It’s been an apocalyptic nightmare here in NYC. The City That Never Sleeps has been hit with a novel COVID-19 a deadly respiratory virus originally to have thought to be found in bats, infected live animals, and eventually humans.
It’s like the main scene of Contagion – everyone is dying frothing at the mouth. Except everyone is dying on ventilators with acute respiratory distress syndrome. Your whole body just attacking your lungs, making it harder and harder to breathe until you need to be intubated.
We now live in a time where we are asking Tesla to make ventilators to address the shortage. Cuomo being the voice of reason, hope, love, and everything New Yorker. He made a hospital at the Javitz Center within a week! We have healthcare frontline workers begging for protective personal equipment (PPE)—gloves, face masks, air-purifying respirators, goggles, face shields, respirators, and gowns — mainly N95s – the kind you wear to prevent TB.
Working at the hospital, we’ve transitioned from doing elective cases to transforming everything into COVID. There have been rumors of sharing ventilators with two patients… As I type this, I see Annenberg in the dark foggy distance with ambulances shrieking and wailing to what seems like every blink of an eye. I feel like I already suffer from PTSD.
Per the NYT: “The total number of deaths in the state stood at 965 on Sunday morning, before New York City reported its most recent count. The number of confirmed cases jumped by 7,200 in one day, putting the total of confirmed cases at 59,513 cases as of Sunday. More than half of the cases, or 33,768, are in New York City, according to the latest figures from the city and state.”
“I used to be a heroin addict, ex-alcoholic too,” he said to me, as his piercing blue eyes looked into mine awaiting judgment and scrutiny. As his nurse anesthetist (student) it took me hundreds of patients later to maintain a neutral response, unscathed by his words but exuding understanding and genuine care instead. After all, I would have to take on his body for the next forty minutes or so. Not only did I have to know what heroin’s effect on the body was and alcohol’s chronic use on his liver, translating into a chronic vitamin deficiency but really how was I going to keep him breathing and safe for the next few minutes keeping his stories in the back of my head?
As I sit here in a Starbucks (after a 10ish hour shift at my 2nd clinical rotation) I can’t help to think about how time is either on your side or not. And for me, I just want to fast forward, become a CRNA, so I can work on endless side projects I have always envisioned. One that sticks out, in particular, is creating a senior center for the Asian community in my neighborhood. Particularly South Asian.
You see, my father was diagnosed with bipolar disorder last summer (coinciding perfectly with the stress of starting summer classes of what I did not anticipate to be the hardest months of my life after) and has been progressing into roller-coaster results. Hospitalized a handful of times of syncope episodes, and medication noncompliance which resulted in being admitted to an inpatient unit. That was not pretty. To watch your father, once an influential surgeon in Bangladesh, Japan, and Vienna regress to childish behavior and being locked up behind the bars of a psychiatric center. Was he always bipolar? Was he just manic all of those times that he had a freak episode in Bangladesh, and people attributed it to him a surgeon?
He’s a lot better now. Besides the fact that he constructed a metallic shiny gate surrounding the perimeter of my house without my mother’s consent I think he is doing quite well. The only other problem is- he is incredibly bored. Amidst his mental disorder, there is just NOTHING to do in my neighborhood besides go to the mosque and pray five times a day. There is no social life. There are no friend circles. Just as we were children, our elderly need to be similarly stimulated or we are faced with a noticeable decline in the activity of daily living. Surrounding retired neighbors are also similarly just as bored as I find them loitering in my backyard, entertaining my dads nonsense bicker.
My point is senior centers need to be a thing. Not just for those who are disabled but for everyone who is getting old. Those are retired and may or may not have grandchildren or means to a hobby. I would love to start this. Back in nursing school for our community nursing clinical rotation we facilitated a “eat better and move more” program for the senior citizen of East Harlem. I would love to mirror this, to have a schedule every day for weight training, walking groups, field trips, educational sessions about nutrition. They seemed to really love it as if they finally had a purpose again. Bangla translators and Bengali young professionals who want to give out pro-bono advice and teaching need apply! 🙂
My name is Jasmin Zaman and I am a 26-year-old going on to be a 27-year-old female (T-minus 5 days) of Filipino and Bangladeshi origins. My background is a blend of culture and beliefs: I was born Catholic, having been baptized as a child as a result of my mother’s Catholic background. However, she later converted to Islam while my older brother and I were still young; hence we did too. Growing up, I learned both Tagalog and English as my native tongue, and when my family moved to Bangladesh, I learned to speak Bangla as well. In the United States, I would go on to take Spanish in school for several years and adopt a fourth language. I consider myself part of a middle-income family; my parents are still married and living together. Consequently, the idea of a family unit is one that is very important to me. Growing up in an immigrant-Asian household the value of education was a top priority and the expectation is that the family raises the children until they are married, then, the children have the responsibility of returning the favor and have to take care of their elderly parents in return.
Culture and values have been exposed to me both in school and from my interactions with the world. From living in a third world country where everyone spoke the same language and practiced the same religion to a melting pot of people who coexist albeit their culture and beliefs is beyond fascinating to me. Hailing from a fairly religious family background, I grew up heterosexual while misconstruing homosexuality, as the idea of being something “different” was shunned upon. I was also made to believe that “white” is powerful. Often times, Filipinos will be found bleaching their skins to be more light-skinned. Actors in tv shows were all light-skinned and this seemed to be omnipresent in the Asian world. Even in Bangladesh, I learned that many of the women used products called “fair and lovely” to also try to brighten their brown skins.
I never understood the value of being a white person until I came to the United States. Let alone, a white man. I would later find out that with all of the political undercurrents, with Donald Trump as the president, racism towards minorities is still omnipresent. White males would take on more powerful roles in most industries while minorities and females were subjugated to more submissive ones with little room for growth. It is to no surprise that Filipino women, just like my mother, are found to be nurses with their caring and nurturing manners. My mother encouraged me tenfold to consider nursing as a profession because as a woman it would teach me not only to understand how my body functions, but to be able to take care of others, and most importantly how to raise children. So, I only continue to be part of the minority – a Brown, Muslim, woman.
I consider myself a product of the NYC public school system. I immigrated here from Bangladesh when I was eight years old. I grew up in the Bronx, went to high school in Brooklyn, and lived in Manhattan for a few years when I attended nursing school. Currently, I live with my parents in the Bronx. My first job was a teacher’s assistant in the specialized high school admission test (SHSAT) program, to help students of the public-school system get admission to a competitive, elite specialized high schools in NYC – such as Stuyvesant, Bronx Science, and Brooklyn Tech. My first job as a nurse was at the Mount Sinai Hospital, providing care to a plethora of patients from the underserved populations of Spanish Harlem and Harlem to the wealthy Upper East-Siders. I am grateful to have grown up in New York City, where all walks of life have learned to thrive with one another – or so I thought.
Living in the Bronx, news of shootings, stabbings, and gang violence is common. However, the recent news of the death of an innocent boy named Junior left me in shambles: a 15-year old approached by five young men armed in machete and kitchen knives would drag him out of the neighborhood deli and take turns ramming their knives into him. How was nobody able to help this boy? Why did Junior have to walk to the hospital and bleed out to death as people stared at him walk by? Have we, as a society, become desensitized to all that makes us human? I have to admit that with the presence of crime in my borough often as a result Black or Hispanic assailant, has left me cautious and undeniably afraid whenever I walk past one. However, being a girl with ethnically ambiguous looks walking in the streets of the Bronx often calls for unwarranted attention and getting cat-called by a group of ANY men is a norm. To say the least, these experiences have allowed me to remain hypervigilant of my surroundings and maintain a sense of “street smarts.”
On a more positive note, I love to travel and explore the world. Some of my favorite places typically include sun and beaches like Greece and sunny California. I love to learn from my experiences, not only during a pursuit of fun but while helping others in need. I was part of a three- week Habitat for Humanity mission to help build houses for those who lost their homes in riverbanks of Pasig City, Philippines after a devastating storm in 2011. It was a humbling experience to help these people who genuinely seemed so happy with having so little in their lives. Travelling has allowed me to keep an open mind and embrace differences people may have. My interactions with so many walks of life have defined me as the person I am today.
What was the most important moment of my life? I would say starting this CRNA journey. I think this was a pivotal point as this is when all of my worlds would collide – nursing, love for others, and the idea of helping people abroad with my medical knowledge. It is actually a dream come true. As a nurse anesthetist, I am excited to use my experiences to understand patients on a cultural and personal level, in order to tailor their care appropriately. As someone who loves to be in control of every situation, I am excited to be their vigilant guardian angel.
In 1936, Dr. George W. Crile, one of the greatest surgeons of all time, said regarding nurse anesthetists: “I think this is one of the most beneficent movement we have seen in the whole field of operative surgery (Bankert, 2013, p. 39).” Anesthesia care in the United States dates back to the 1800s and the turn of the twentieth century. To meet the needs of patients, American surgeons trained and recruited nurses during the Civil War (Koch, 2015). A shortage of anesthesia providers, combined with the reluctance of physicians to accept lower pay and a subordinate role, led nurses to take on the role. Surgeries were made possible by the introduction of certain techniques and a collaborative effort of the nurse anesthetist-surgeon relationships. The purpose of this paper is to highlight three nurse anesthetist-surgeon collaborations to purport their use in the anesthesia shortage in low and middle-income countries like Uganda and Kenya. The insight of each collaboration reflects a potential road to success for future collaborations and contributions to anesthesiology innovation and techniques.
Surgeon-Nurse Anesthetist Collaborations
Alice McGaw and Charles Mayo
Alice McGaw and Charles Mayo mastered the open-drop technique of anesthesia when they administered ether and chloroform by dropping it through a cloth instead of pouring, making the induction of anesthesia less barbaric. Medical providers came from all over the world to watch the nurse anesthetist techniques that were being performed at the Mayo Clinic. “Notes on the Administration of Anesthetic in America, with Special Reference to the Practice at the Mayo Clinic” was presented to the Section of Anesthetic of the Royal Society of Medicine in 1912 (Bankert, 2013, p. 35). This highlighted the significant impact of the nurse anesthetist role in the changing world of surgery.
Hodgins and Crile
Agatha Hodgins was celebrated for the nitrous oxide technique she performed with surgeon Dr. George Crile. Dr. Crile acknowledged “the administering of an anesthetic is not only an art but a gift. In my mind, it ranks close to the work of the operating surgeon… Miss Hodgins made an outstanding anesthetist for she had to a marked degree both the intelligence and the gift” (Bankert, 2013, p. 41). Crile and Hodgins also succeeded in starting the Lakeside Hospital of Anesthesia where the nurse anesthetist service and training flourished. Hodgins later went on to become the founder of the American Association of Nurse Anesthetist (AANA).
Graham and Lamb
Finally, Dr. Evarts A. Graham was considered the father of modern-day chest surgery, working alongside his nurse anesthetist, Helen Lamb. Lamb introduced and taught the practice of endotracheal intubation. This duo worked together to come up with an anesthetic plan for the first pneumonectomy in the US. Koch (2015) mentioned that Helen Lamb understood the concept of positive pressure ventilation well before her time, as she compressed the breathing bag continuously throughout the 165-minute operation. Lamb proved that aside from her innovative ideas, she was also built to be a leader when she served as president of the American Association of Nurse Anesthetists and chaired its powerful Education Committee (Koch, 2015).
Anesthesia Shortage in Low and Middle-Income Countries
Dubowitz et al. (2009) mentioned that sub-Saharan African countries are suffering from a lack of anesthesia providers. In Uganda, there are approximately 14 physician–anesthesiologists for a population of more than 30 million people. Neighboring country Kenya has a total population of 32 million people, yet there are only 13 out of 120 anesthesiologists who work in public hospitals. In comparison, in the US the ratio is an estimated 1 anesthetic provider per 4,000 population. Uganda and Kenya have programs in place utilizing “nurse anesthetists” in an attempt to address the anesthesia shortage in these countries. Similar successful programs have been implemented in Malawi and Mozambique, Nepal, and Iran (Dubowitz et al., 2009).
In the future, the United States and the AANA should employ humanitarian efforts to alleviate the anesthesia shortage in the developing world. Alongside other US-trained nurse anesthetists, I hope to partake in the start of many nurse anesthetist schools. This will increase utilization of the anesthesia provider to close the growing gap between the number of providers and surgical need. By doing so, we can encourage leadership roles in the nurse anesthetist profession.
In the United States, the birth of nurse anesthesia came from a dire shortage of anesthesia providers in the surgical arena. Anesthetists have pioneered the field of anesthesia with arrays of techniques and devices to enhance patient experience during surgery. Good rapport, training, and teamwork are reflected in the aforementioned nurse anesthetist-surgeon collaborations. In these examples, it is evident that nurse anesthetists are competent in providing safe anesthetic care and are respected by fellow surgeons, in addition to trailblazing the profession by taking upon leadership roles in the national association (AANA). By understanding and learning the history of anesthesia practice and development, it is crucial to employ the nurse anesthetist- surgeon collaboration method to address the shortage of anesthesia providers around the world and to promote future leaders in the nurse anesthesia profession.
Bankert, M. (2013). Watchful care: a history of Americas nurse anesthetists. Park Ridge, IL:
American Association of Nurse Anesthetists.
Dubowitz, G., Detlefs, S., & Mcqueen, K. A. (2009). Global anesthesia workforce crisis: a
preliminary survey revealing shortages contributing to undesirable outcomes and unsafe practices. World Journal of Surgery,34(3), 438-444. doi:10.1007/s00268-009-0229-6.
Koch, B. E. (2015). Surgeon-Nurse Anesthetist collaboration advanced surgery between 1889
and 1950. Anesthesia & Analgesia,120(3), 653-662. doi:10.1213/ane.0000000000000618