Time flies when you’re having fun, or doing something you love to do. For me, this year’s renewal of my license marked 52 years of belonging to the greatest profession I could ever have chosen. It will also be my last, and the younger, much more highly educated need to take over care of the many patients on the roads less traveled.
When I began my classes in September 1963, I was in a large 500 bed teaching hospital in Massachusetts, where we had surgery residents, student RN nurses, a School of Anesthesia run by a solitary CRNA, and general practitioners providing a lot of the anesthesia. We were mainly using open drop Ether proceeded by an ethyl chloride induction, or Cyclopropane and N2O/O2 via a red rubber non disposable ET. We had thiopental occasionally, but mostly methohexital. Both were rather barbaric as I now compare them to propofol.
I graduated June 1968, took boards the following week, and was immediately put into an OR with cases. In our 7 room OR, we had one trained MDA from Holland, 3 CRNAs from the prior class, one bullet EKG monitor that was used on the sickest patients of the day, manual blood pressure cuffs and E cylinders for O2. Our pharmacy “draw” consisted of morphine, demerol, ketamine, atropine, valium, vistaril, meprobamate, phenylephrine, epinephrine, norepinephrine, and succinylcholine (yes, it wasn’t refrigerated then). Our syringes were glass and the needles were metal.
Every patient got an IV of 5% D/W administered via an 18 gauge non disposable needle. Our machines at first were VERY basic with tanks for O2 and N2O and a #8 ether vaporizer and NO ventilators. We eventually got Copper Kettles, a new narcotic called Nisentil, and an inhalation agent called Ethrane that we vaporized in the #8 vaporizer.
Our hospital also had an extension for really critical TB patients that we would treat with inhaled ether…..how barbaric!
During these years I’ve had one MH patient, one cerebral air embolism, one amniotic embolism, and 150 ruptured AAAs. I learned a lot through trial and error and how to work alone, and CRNAs have come far in these years with advanced education, the equipment has become state of the art, drugs have improved vastly but, we still have much to learn. I ask those behind me to continue learning, be vigilant in their care, kind in their approach, honor and preserve our profession and never forget that we still are the best kept secret.