CRNAs – Everyday Heroes

Dennis, I’m sending you a link to a You Tube video that was made by a News station here about a situation that happened with my daughter. I’m sending it because it shows the importance of early CPR and “when seconds counted” it was 2 CRNAs that saved my daughter’s life. If you want to share it on your CRNA website, feel free to do so.

Katrina Vice O’Con

 

Have we forgotten we are even at war ?

Plane hitting 2nd towerDo you remember where you were on one day in September of 2011? 

September 11, 2001 was a day that the world changed as we know it. For us it was one of those rare few days that we knew exactly where we were and what we were doing. It will be forever locked in our memory.

It was a day that would push us into two wars on two different fronts and fighting a new enemy that had no boarders.

The numbers speak for themselves and should haunt our soul.

Operation Iraqi Freedom:

Service Members 4,409 killed;

DOD civilian deaths 13


Service members wounded 32,925

Operation New Dawn (surge in Iraq)

Service Members killed 86

Wounded 295

Operation Enduring Freedom (Afghanistan and all other non-Iraq engagements)

Service members killed   2,165


Wounded 18,230

Have we forgotten ?

It is odd, sitting here on the first day of another active duty tour. In fact our 4th tour of duty for current combat operations. I am a 12th generation soldier. My family has been in the military since the inception of this country. I am only the second officer to have served and the first since a battle field commission in the civil war. It is hard to imagine life without war.

My generation has been engaged in combat operations since 1995 (Bosnia and we still have combat rotations to this area of operations). This is just my generation and not all the ones before us. We walk day to day with the heroes of the battle fields of Vietnam.

My father a veteran of two tours of duty in Vietnam himself. He served with honor as did all his fellow veterans. Our grandparents were in Korea and fought on beaches and jungles all around the world during World War Two.

To put it in to perspective I have a 8th grader this year and he was born as the war in Afghanistan started and my second son was born as I went to fight a war in Iraq. They have not known a time of peace.

Globally we needed to ask the question, have we forgotten we are even at war? There once was a time when flags flew from every porch in our town. We tied ribbons around the old oak tree and we remembered our men and women in harm’s way

We get asked a lot of why we serve, why we do what we do. It is a totally volunteer military. Not since Vietnam have we had a draft. Yet, young men are still required to register for selective service. Why are we willing to volunteer for service? My story is not unlike many of those I serve with. In the most basic of terms, I do it for my family, I do it for my children. P.Strube children

There is an age old poem that sums it up best: “We fight not for what we fear in front of us; but for what we love behind us……….” I hope someday soon my children will not have to wear the uniform.

We put the uniform on each day so someday our children will not have to wear one and not have to carry a gun in the protection of freedom. Freedom is something we take for granted each day. We spend time and hours arguing about “losing” freedom without ever understanding the freedom we do have.

I serve for the protection and defense of that freedom. I also serve for another more deep and dark personal reason. We are always spending time in lives looking for answers. We look for things small and large and in many reasons the curiosity we have as childhood morphs into adulthood and we are just searching for answers.

The biggest of questions we all have is “what was my father like, or can I find a way to be closer to him” Fathers are a mystery. I am in no way saying anything against mothers, so please don’t think that; but, as a son, I am always wishing for more of my father. I suppose this can be said of my children too. Do they wish more of me and to understand me more?

For me service included an attempt to answer that question. What was my father like? All I ever knew was the alcoholic man that had returned from the battlefields of Vietnam. Always a bit cold and distant and never sober.

Little of my childhood memories are of him warm and laughing. If he was happy, there were beer bottles lined up in the sink. Maybe, just maybe my service would allow me to have a better relationship with him. Maybe by walking in his shoes would I be accepted as a man and he would be proud of me.

I have never asked him what his combat was like nor should anyone ask a veteran what combat was like. It is a deeply personal topic and only those that have worn the boots can listen and understand.

When I returned from Iraq my father looked just a bit different at me. When I “saw the elephant” for the first time he actually wrote one of only two letters he has ever written to me. Telling me it would all be ok.

A few simple words telling me it would be ok. He has since told me a few pieces of his life, but I only listen and don’t ask much. I serve for him and to build a relationship with my father and I serve for all the sons and daughters so their relationships can be better. I serve for the love of my family, not because of what I fear ahead but for what I LOVE so much behind.

So have you forgotten the war? Have you forgotten our men and women in combat and in the military? We say we honor them, but think deep, do we really? I ask you this?. Can you remember the last positive thing your did for the military or for your community that was purely positive and selfless? A simple no strings attached positive act?

The warrior Ethos is simple:
Warrior Ethos
I will always place the mission first.
I will never accept defeat.
I will never quit.
I will never leave a fallen comrade.
We will take a journey in these articles. We hope to offer a bit of insight into what it is like to be a soldier and a soldier’s family. I have attached the Army Values Statement as a place start.

Loyalty
Bear true faith and allegiance to the U.S. Constitution, the Army, your unit and other Soldiers. Bearing true faith and allegiance is a matter of believing in and devoting yourself to something or someone. A loyal Soldier is one who supports the leadership and stands up for fellow Soldiers. By wearing the uniform of the U.S. Army you are expressing your loyalty. And by doing your share, you show your loyalty to your unit.

Duty
Fulfill your obligations. Doing your duty means more than carrying out your assigned tasks. Duty means being able to accomplish tasks as part of a team. The work of the U.S. Army is a complex combination of missions, tasks and responsibilities — all in constant motion. Our work entails building one assignment onto another. You fulfill your obligations as a part of your unit every time you resist the temptation to take “shortcuts” that might undermine the integrity of the final product.

Respect
Treat people as they should be treated. In the Soldier’s Code, we pledge to “treat others with dignity and respect while expecting others to do the same.” Respect is what allows us to appreciate the best in other people. Respect is trusting that all people have done their jobs and fulfilled their duty. And self-respect is a vital ingredient with the Army value of respect, which results from knowing you have put forth your best effort. The Army is one team and each of us has something to contribute.

Selfless Service
Put the welfare of the nation, the Army and your subordinates before your own. Selfless service is larger than just one person. In serving your country, you are doing your duty loyally without thought of recognition or gain. The basic building block of selfless service is the commitment of each team member to go a little further, endure a little longer, and look a little closer to see how he or she can add to the effort.

Honor
Live up to Army values. The nation’s highest military award is The Medal of Honor. This award goes to Soldiers who make honor a matter of daily living — Soldiers who develop the habit of being honorable, and solidify that habit with every value choice they make. Honor is a matter of carrying out, acting, and living the values of respect, duty, loyalty, selfless service, integrity and personal courage in everything you do.

Integrity
Do what’s right, legally and morally. Integrity is a quality you develop by adhering to moral principles. It requires that you do and say nothing that deceives others. As your integrity grows, so does the trust others place in you. The more choices you make based on integrity, the more this highly prized value will affect your relationships with family and friends, and, finally, the fundamental acceptance of yourself.

Personal Courage
Face fear, danger or adversity (physical or moral). Personal courage has long been associated with our Army. With physical courage, it is a matter of enduring physical duress and at times risking personal safety. Facing moral fear or adversity may be a long, slow process of continuing forward on the right path, especially if taking those actions is not popular with others. You can build your personal courage by daily standing up for and acting upon the things that you know are honorable.

Kennedy spoke of these things in his inaugural address of 1961:     “Let every nation know, whether it wishes us well or ill, that we shall pay any price, bear any burden, meet any hardship, support any friend, oppose any foe to assure the survival and the success of liberty.”

Major Peter Strube

 

In closing, I ask you and I ask all of us a simple question.

Have we forgotten?

Has our apathy won?

Have YOU forgotten?

Major Peter Strube, CRNA

May this keep you safe in foreign lands…

Trollway in Afghanistan.
black hawk med evacIt is 3:40 am and a loud knock is heard at the door. A voice yells incoming GSW (gunshot wound) estimated arrival via Blackhawk is 20 min. We stumble from our beds, don our boots and scramble the receiving area.

My fellow CRNA and I once in the operating room quickly separate, he heads to the anesthesia machine to prep the machine and bed, I head to the advanced trauma life support receiving area only 20 feet away. I quickly check my supplies, draw up drugs, ensure my airway devices are ready and have the medics prime blood tubing.

The clock slows to a point where minutes feel like hours, seconds like minutes and we wait for the sound of the incoming bird. The door opens with the executive officer announces the patient is no longer coming. An awkward silence falls over the room. We quietly clean our areas and mourn for the dead. As the ranking officer in the Department of Anesthesia and co-chief I find words hard to come by. I scramble back to my bed to get my new Afghanistan phone to contact my family to advise them that I am ok and that I miss them.

At the end of my roommates bed is a quilt. On the lower corner is a hand stitched signature that reads “hand crafted with love of our troops, may this keep you safe in foreign lands.” operation gratitudeI am moved to send her an email or something to tell her of this power gift to us. I think of all the son’s and daughters that won’t be coming home. I wonder about the parents, brothers, sisters, wife and children that have lost a loved one. I hope and pray there are always people to stitch quilts for those they don’t know. I hope to be a better man, father, and husband and community member to honor their memory.

We practice scenarios and live patient play to refine our team skills and prepare for our next test. I hold mini classes with our young medics. They eat the information up and are excited to learn. They are eager to learn why things work, the physiology and physics of what we do and how we resuscitated and save patients. I have hope in them for the future. I believe the will perform amazing things as each patient arrives at our door.

As the day ends and darkness of the moon takes hold we are greeted by another announcement “Attention on the FOB, outgoing fire”. Then a few minutes later the cannons fire off into the distance. The sound wave hits us and we feel the power of the guns. The deep feeling in our bones as we are rattled by the continued echo of shell after shell of outgoing fire. This feeling is very different than the incoming rounds. The ground does shake and you can feel the train engine on the tracks as incoming rounds are felt. This is different and gives us a sense of safety if only for a few minutes.

In closing, I leave you with a prayer I wrote on the eve of war when I was first mobilized in March of 2003. I keep it in the bible my Grandfather and Grandmother gave me when I was mobilized. This prayer and the bible have deployed each time with me. I hope it brings us all some closure on this day.

The flame of freedom burns bright in the heart of a soldier

Our sacrifice to family and friends for duty, honor country carry us
To the 4 corners of the world and is understood little by those not among us

We bring water to the desert, warmth to the cold and food to the hungry

We bring law to the lawless, medicine to the sick, hope to the hopeless and freedom each

Our sacrifices like the sacrifices of those that have gone before us help ensure
Freedom of speech, the right to protest and the freedom of religion

We do this faithfully and all we ask is a piece of hallowed ground to bury our dead

The path to freedom, to hope, to prosper and serenity is not an easy path

flag draped coffinIt is a path forged and protected by the soldier

Our flag represents to us the ultimate sacrifice paid by our fellow soldiers

When my coffin is draped in it, remember that a true patriot is beneath

God Speed and God Bless.
www.trollwayanesthesia.com
Big Sky March 3-8 2015

CRNA or Anesthesiologist – Any Difference in Care ?

Cochrane Summaries   July 2014
Physician anaesthetists versus nurse anaesthetists for surgical patients     

Conclusion: As none of the data were of sufficiently high quality and the studies presented inconsistent findings, we concluded that it was not possible to say whether there were any differences in care between medically qualified anaesthetists and nurse anaesthetists from the available evidence.

Despite the Cochrane Collaboration conclusion, the American Society of Anesthesiologists (ASA) reached a very different conclusion:

EVIDENCE-BASED REVIEW DID NOT FIND NURSE ANESTHETISTS’ CARE EQUAL TO THAT OF PHYSICIAN ANESTHESIOLOGISTS  – American Society of Anesthesiologists  August 2014

Interestingly,  science and physician related websites who were quick to publish the ASA’s public relations opinion have since retracted this blatant PR piece.

An anesthesiologist’s perspective:

“The inability to document the superiority of anesthesiologists versus CRNA’s in the final result doesn’t exactly conform to the screaming headline the ASA is trying to plaster all over the internet. Is the ASA becoming so desperate in its attempt to disparage the nurses that they will twist a scientific paper to justify its own personal beliefs even if the paper doesn’t support that goal in any way?”

“Everyone is entitled to their own opinions, but they are not entitled to their own facts.”   Daniel Patrick Moynihan