Well its official. I passed boards. The notice of board results can be seen at the AANA web site under Certification Verification. After taking that crazy board exam I was perplexed as to how I actually did on the exam so its been a long ten days checking for results each morning at the AANA web site. We are precluded from discussing the exam itself but I can tell you that the board exam from the CCNA is very probing and examines your knowledge and understanding of physiology and the anesthetic implications at very sophisticated levels. My exam shut off at 90 questions. From what I have heard from other people this is either very good or very bad. The board exam is a test that learns from your answers what questions to give you tailoring each test individually selecting questions out of the very large pool. Each test is different if I understand this correctly. This has been a long and difficult road climbing this mountain but the view from the other side is terrific. Just take a look at the view.

Currently Jennifer and I are in Shanghai visiting her parents for the Chinese Moon Festival. Each morning I would get up first thing and turn the computer on and go to the AANA web site looking for the board exam results. I know that sounds nuts but I just could not wait for the mail and the end of our trip overseas to find out the results of the board exam.

So what can I now recommend as study preparation for the board exams you ask. First I would not put off any review for the board exam but to study daily the entire time while doing clinical rotations. A through review of medical physiology is a must. My choice is the LANGE publication by Ganong, “Review of Medical Physiology” as a must read. This is not a large text but dense and will require several months of careful reading and rereading to gather the appropriate understanding of the specific anatomy and physiology that is required knowledge to do well on the nurse anesthesia board exam. Maybe I could give you a general example of how specific the board exam is.

One of the favorite subjects on the board exam has been the endocrine system and the interactions with anesthesia. The pituitary glad as you may recall is located in the Sella Tursica, a cave like bony structure and is histologically divided into three sections. In humans the intermediate lobe section is underdeveloped and rudimentary. The posterior pitutiary or neurohypophysis is the site of excretion of ADH (vasopressin) and oxytocin which are structurally similar. It is interesting to note that oxytocin has antidiuretic qualities because of the structural similarity of these two hormones. I digress. The point I am getting to is that the source of the posterior pituitary hormones in from higher structures in the hypothalamus, specifically the supraoptic and paraventricular nuclei. Nerve axons project from these structures and descend out of the “Blood brain barrier” down to the posterior pituitary where they are released when physiologically stimulated. A full review of this and all of the physiology surrounding these structures and the actions of all of the hormones along with the anesthesia implications is highly suggested. Ganong’s Review of Medical Physiology and the Anesthesia and Co-existing Disease book by Stoelting are both highly recommended.

Brother, that was a mouth full. So which part of this do you need to know to pass boards? I am afraid that this is just a small example of the detail between structure and function that is requried. Its been overwhelming and the more that I study the more I realize that I know very little.

Good luck to all that are preparing for the board exam and don’t forget the small details. I guess it would be correct to say that knowledge at a superficial level will leave you really perplexed when you take boards while knowing the fine details will help you navigate your way through the questions. Again good luck.

The University of Southern California program of nurse anesthetist awarded Bob Naruse, M.D. the faculty award this year. Dr. Naruse is staff anesthesiologist at Cedars Sinai Hospital where many of us do our neuro rotations. It is here that I met Dr. Bob and became acquainted with the low opioid techniques for craniotomy surgery that are routinely used there. Today several of our classmates were able to present the award to him in person. Unfortunately I was not able to attend but sent my best wishes and called him on the phone as a follow up.

Our lives have been enriched by his mentorship and example of excellence in patient centered anesthesia care. Thank you Dr. Bob Naruse and we will all make you proud. What follows is a letter I received from him after today’s presentation.

Dear ‘SC Class of 2006,I must admit that I am truly touched by your award. Working with such a distinguished group of anesthetists made my job easy and fun. I can’t remember a class that I’ve enjoyed more than yours. I know that each of you will be outstanding anesthetists for years to come and I want to congratulate each of you for the great achievement of completing graduate school. I am proud of you.

Please pass along your knowlege, especially that which is not in the textbooks. I know that eventually your colleagues will be impressed with your airway management skills as am I. We owe it to our patients to provide the best care possible.

Take care and best wishes in the future. Fight On!!!

Yours truly,
Bob Naruse
Da cedarsgasman

So there you have it. This week many of us are studying for CCNA board exams. My test date is the 20th of this month. Pressure, a little, confidence, a lot. I will let you all know how our class does.

Its all finished folks. After two years and a lot of hard work the class of 2006 from the Keck School of Medicine department of Anesthesia has graduated the next group of nurse anesthetists. The University of Southern California program for nurse anesthetists has been terrific but I am so glad to be finally finished with this step in education.

After this weekend I will buckle down to several weeks of intensive study for board examinations. Following this Jennifer and I will take some time for ourselves before I start work November 1st. Isn’t life great!

Congratulations to all around. This came in the mail today and to say that I am happy is the least of it. The long hard road through this part of our education is coming to an end while the broader path is open for us.
Right now I am going to make a few phone calls just to hear the cheers go up and see the streamers fly when people hear the news. This makes it official and the reality of actually graduating is sinking in. Maybe for others this has been a cakewalk but that has not been my experience. Anesthesia training is tough, rigorous and very demanding as it should be. To finally approach this milestone is… hmmmm…what is it? I guess my breathing is just coming a little easier now and the smile on my face will not leave for a long time it seems. That just about sums it up for me at the moment. Just like this picture of a happy birth that I was privileged to participate in, my joy is complete.

August 17, 2006

Dear Mr. David Roy Godden:

Congratulations! The Degree Progress Department is pleased to inform you that your Master of Science in Anesthesiology degree has been conferred and posted to your academic transcript at the University of Southern California. The conferral date of your degree is August 8, 2006.

Your diploma has been ordered and, unless you have requested that it be held for pick-up or you live in the 90007 zipcode, it will be mailed to your address of record. If you have not received your diploma by September 21, 2006 please contact the Degree Progress Department at (213) 740-7070.

If you require official confirmation of your degree, you can find information on ordering an official record verification by visiting http://www.usc.edu/verification. There is a $5 charge per record verification. You can also find information on ordering an official transcript of your entire academic record, including your degree, by visiting http://www.usc.edu/transcripts. There is an $8 charge per academic transcript.

Again, congratulations on this achievement. You have completed a demanding course of study and we are proud to have you join that select group of individuals who are graduates of the University of Southern California.

Degree Progress Department
University of Southern California

Our graduation ceremony will be September 2nd…just a couple of days…..Yippppy!!!! I will see all in clinical tomorrow bright and early. Only 10 days left of clinical rotations. For me its Big County general surgery in the morning.

I received a wonderful email today from Gina my Pal with a capital P. As you may recall Gina has been a practicing doctor of chiropractice medicine and decided that this was not enough for her. We have now been classmates for two years in the anesthesia program at the University of Southern California and will be graduating soon….this month in fact. This short note came today in an email from her which I just had to share. I will get back to you about what has been going on with me and why it has taken me so long for any new posting on this web site. Her letter follows. Thank you Gina for for your friendship and genius. You have been an inspiration to me.

Dear Class,

The clock is ticking my dear friends and we are so close to the end, my pulse is quickening as I type this. My very best hopes and wishes for all of you as you start your careers. You are such an amazing, talented group of people, and it has been a tremendous privilege to know you and experience this adventure with you. If ever I can be of service or help to any of you, please never hesitate to call.Which brings me to the point of my email. We are spending our last moments as the class of 2006, and already are starting to spread our wings; we know amy is headed to the great Northwest, and several others are looking across the country for our first positions (Aloha, Manda Manda?). I would like to propose that we elect one of us as a point of contact person for the Great and Wonderous USC Class of 2006; someone whom we could email or call for current contact info on a classmate. Douglas won’t have that usc.edu email address forever [unless he starts an affair with Dr. McDonaugh (sp)], and I’m pretty sure Helen will be getting a new address and phone number once she’s married. I know from past experience, as I’m sure you all do, how quickly a class can get scattered to the winds, all the more so with a profession such as ours where mobility is a key feature.

Is there any of us who would proclaim themselves stable enough for such a role? If I want to know what Joy’s new email address is, or Lunsford’s phone number, who could I call? Keep in mind that we could be using each other for letters of reference as our careers develop. Or in the case of Lunsford, I might just be thirsty and want to have a beer with my old friend from USC (Downtown Brown, of course). Remember part of why we chose USC was for the alumni connection. Since it’s not bloody likely most of us will be active in the USC Alumni Association proper, let’s create our own little Association. Let’s stay connected.

I immediately thought of either David Godden or Karen for the role, as they are both Uberorganized, and soon to be entrenched, I mean immersed at LAC/UH, which sounds pretty stable to me. Either of you interested? Somebody else feeling ultra stable and want to volunteer? I just don’t want to risk losing touch with this group of people I have learned to love like family (without the hairpulling, namecalling, and clothes borrowing dysfunction).

BTW, Karen, Godden, and Manda Manda, Dr. Yasafusifusi from Cedars spoke very highly of you today.

Have a great finale everybody. Looking forward to seeing you on the 2nd.

gina~ They can’t stop the clock!

So there you have it from Gina. You are such a peach. My bet is that Gina will be world famous one of these days. She has that special something, the charisma and intellect to really make things happen. It has been such a gift meeting her and the rest of the friends that I have made during these last two difficult years. Which brings me to why I have not posted more in the past months.
This is actually difficult to write or disclose. School, that is academics, is easy - at least for me. Many people struggle with memorizing vast numbers of facts but not me. I am pretty good at that. What has been difficult is dealing with the scrutiny and criticism of a few during clinical rotations. I wish that I could tell you that all it takes to be a great practitioner is intelligence. This is not the case. I have thrived in the clinical arena and done well in supportive environments and have suffered during difficult assignments where small people feel better about themselves when they can dominate and put others down - that means me. I guess this is important information for anyone that is interested in going on and pursuing nurse anesthesia. It is a difficult road where the gauntlet must be run well and no one comes through unscathed. This last month has been particularly brutal. I have survived and continue to thrive which is the good news.
This month of clinical rotations is in General Surgery at a big County hospital and it is our last. This past week has been very busy but wonderful, coming home and back to friends that I have grown up with in anesthesia. The surgeries here at the County have been complicated and intense but really interesting and handled well. My confidence has increased a thousand fold this past week which is the good news. I am so glad to be home.

So I have not written anything for a while now because I have been too stressed out, busy and just plain tired. Working 12 to 14 hours in the operating room then the travel time not to mention all of the preoperative preperation that has to go on just leaves little time for writting. You understand. Maybe this is all good information and will be taken to heart by anyone interested in nurse anesthesia.