If you are an AA student and loved hearing the knowledge bombs dropped in Sabena's episode #40, then you will really love this student focused episode. Have you ever wondered how it would feel to take your developing skills to an entirely new environment? Experience the stress and the thrill of autonomy? Embark on a mission of hope, healing, and education? Today, we peak behind the curtain of two brave 2nd year AA students from the CWRU- Austin AA program as they recount the ups and downs of their recent medical mission trip to Uganda.
Pic of the anesthesia circuit Michael mentioned HERE.
Medical Mission Agencies with CAA history:
https://mmomusa.org/
https://www.medicalmissionsfoundation.org/
Join To Be Magnetic neural manifestation
Use promo code AAPODCAST15 for 15% off annual or monthly Pathway membership
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Want more? Stay in the know by subscribing to the Awakened Anesthetist Newsletter- more resources, exclusive content and ways to connect.
Let's Chat! Contact me:
awakenedanesthetist@gmail.com
IG @awakenedanesthetist
If you are an AA student and loved hearing the knowledge bombs dropped in Sabena's episode #40, then you will really love this student focused episode. Have you ever wondered how it would feel to take your developing skills to an entirely new environment? Experience the stress and the thrill of autonomy? Embark on a mission of hope, healing, and education? Today, we peak behind the curtain of two brave 2nd year AA students from the CWRU- Austin AA program as they recount the ups and downs of their recent medical mission trip to Uganda.
Pic of the anesthesia circuit Michael mentioned HERE.
Medical Mission Agencies with CAA history:
https://mmomusa.org/
https://www.medicalmissionsfoundation.org/
Join To Be Magnetic neural manifestation
Use promo code AAPODCAST15 for 15% off annual or monthly Pathway membership
not quite ready?
Want more? Stay in the know by subscribing to the Awakened Anesthetist Newsletter- more resources, exclusive content and ways to connect.
Let's Chat! Contact me:
awakenedanesthetist@gmail.com
IG @awakenedanesthetist
Welcome to the Awakened Anesthetist Podcast, the first podcast to highlight the CAA experience. I'm your host, mary Jean, and I've been a certified anesthesiologist assistant for close to two decades. Throughout my journey and struggles, I've searched for guidance that includes my unique perspective as a CAA. At one of my lowest points, I decided to turn my passion for storytelling and my belief that the CAA profession is uniquely able to create a life by design into a podcast. If you are a practicing CAA, current AA student or someone who hopes to be one, I encourage you to stick around and experience the power of being in a community filled with voices who sound like yours, sharing experiences you never believed possible. I know you will find yourself here at the Awakened Anesthetist Podcast. Welcome in. Hey there, awakened Anesthetist Community. This is your host, mary Jean, and welcome to this special bonus episode of Awakened Anesthetist Podcast. After I decided that I was going to interview Sabina specifically about taking a medical missions trip, I of course had my radar out for anyone else who was talking about that, and it just so happened that on Instagram I caught that the Case Austin AA program had just got back from their own medical missions trip and that two students had gone on that mission trip, and so I quickly DM'd whoever answers the Case Cleveland Instagram account and asked if I could have their contact info. One thing led to the next, and I got in contact with their program director and then was able to set up two really impromptu conversations about these two student experience on their most recent medical missions trip to Uganda. And you're about to hear those two conversations, one of which the student was waking up in a hotel room on one of his away rotations, and the other one happened to be in the hospital hallway, and so you're going to hear a little bit of background noise and just you know the daily noises were all used to because it wasn't in a totally isolated quiet environment. But both their stories shed so much more light on what it means to be an AA student, in this instance going on a medical mission trip. But really anyone in our CAA community who is going on medical missions or wants to go on a medical missions is going to really benefit from these impromptu conversations. I hope you enjoy this bonus episode. Let's jump right into them. Today we have a special student guest on Awaken Anesthes podcast. He is a current Case Austin student and he just recently returned from a mission trip and I wanted to really get the student perspective to back up what Sabina said and shared on her process episode, so we can really expand both professional, current CAAs and AA students. So welcome, michael, to Awaken Anesthes podcast and I would love to just start us off with telling the listeners where you are in the world, where you are in school, what year and just a little bit about yourself.
Speaker 2:All right, my name is Michael. I'm a second year A student at Case Austin. As you already mentioned, I'm about halfway through my second year. It's a 24 month program here at Case. Right now I'm on my trauma rotation in Lubbock, according to my hotel room.
Speaker 1:Well, awesome, okay, and you just got back from a mission trip and I found out about it and I was like, oh, I want to get the student perspective. So start us off with where you went in the world and then I want to take us to how you got there, like how students ended up being able to go on this mission trip. But first tell us where you went.
Speaker 2:So we were in Uganda. We landed in Gulu, which is one of the largest cities over there. Talk about a four hour bus ride north to a hospital there. In terms of how we got there, how we heard about it, about probably halfway through our first year or so, probably about 12 months or so before this trip actually happens, our program director, ty, who had some ties to Kansas City where this mission trip is based out of, kind of broached the subject with us, kind of introduced the topic like oh yeah, you know, this is something I've done before. He's done this trip a couple of times in the past. I don't know if they'll let me take students, but just kind of floating that out there, and he talked about a little bit about what he does, shown some of the interesting cases they did over there. So that was kind of floating around in the back of our mind and then, I don't know, maybe six months after that, near the start of our second year, he was like yeah, so it's going to work out where they're going to allow me to take two AA students. If anybody's interested, just talk to them, let them know. I knew I was pretty interested from the first time he mentioned it. So he came back the second time I was like, okay, yeah, I'm definitely going to talk to him about it. So it's pretty informal thing really, where we just kind of went, discussed it, kind of talked about some of the pros and cons If that was something that we'd be interested in. It was definitely something I was interested in, my classmate Alex as well.
Speaker 1:So it was a Kansas City agency, a local missions agency that Ty had been affiliated with, and Ty Townsend is a CAA. He's the current program director of the Gays Austin program and he just said hey, I have some personal experience with this particular agency. I wonder if I can just use my personal connections to ask them could students come on the next trip?
Speaker 2:Correct, yeah, and the anesthesiologist who was there with us, somebody he'd worked with before, somebody he had a personal relationship with, so I think that was probably instrumental in allowing a student to go. I think because they knew him they trusted him.
Speaker 1:Yeah, after speaking with Sabina, who a lot of people now will know a lot more about mission trips I'm actually recording this with you before that episode comes out but she informed me that so much of this is about breaking through that barrier of educating what an AA is. A lot of medical missions agencies don't know us, and so one of the tactics to get around that is to find an anesthesiologist who already knows AAs, who's also done mission trips, and kind of use that as your connection, and in your instance it sounds like we use that connection. And then also had another layer, because you guys knew Ty Townsend, a CAA who had done this so awesome, okay. So now I would love to hear what you expected when you went over to Uganda for this mission trip. Like, how much did you know? Did you practice? What point in your education were you? Did you feel like, oh, I can absolutely intubate anyone. Tell me a little bit about that.
Speaker 2:Yeah, I mean, I think this mission trip kind of came right at the point in second year we're, you know, you're starting to feel pretty comfortable with most kinds of cases, you know, but it I think it definitely kind of threw a wrench a little bit. You know, the cases that you do are kind of determined on what kind of surgeons came with us with our mission trip. We had one pediatric surgeon and then one burn specialist who ended up doing a lot of pediatrics and that was not something that I was expecting. I hadn't done my pediatric rotation yet. So, kind of what we found out, maybe like a week beforehand, like, oh, here's, you know the case we're gonna be doing. It's gonna be a lot of peeds, yeah, and some pretty sick peeds. We're like, oh no. So I kind of do a little crash course in pediatric dosing and pediatric anesthesia and my classmate Alex helped me out a lot with that. She's a super into pediatrics. I think she's already committed to work at a pediatric hospital when she graduated, so she definitely helped me get up to speed on that.
Speaker 1:And what did you expect to be doing? Like had your program director who's who was going along with you on this mission trip, did he say, okay, expect to run the case just like you would here in the States, or hey, you might only do a little sliver of this. You know what were your expectations for actually hands-on participation.
Speaker 2:No, the expectation definitely was that you're gonna be, you're gonna be running the case. I guess I mean pretty much the same model will be used over here with like a four to one. There it was a three to one one anesthesiologist, the anesthesiologist Ty, who's an anesthesiologist assistant, myself, my classmate Alex, and then there was a CRNA student as well, in her third year, and so between the five of us we were managing three rooms. So I guess just a lot of trust there. And I think that's where that personal connection came in.
Speaker 1:So you, had your own room. Yeah, oh my gosh. And Ty sort of vetted the two people, you and Alec, to say you guys are ready for this experience. That is, that's a huge responsibility. Wow, okay, what an awesome experience for you to be able to be given so much trust early on in so much autonomy. Absolutely I would love, because I'm imagining myself as a student going to a mission trip and being like all right, you have your own room. Like what did that first case feel like? Did you know? Okay, I'm walking into the OR today. I'm doing my first solo case. Here's how I'm going to prepare, or was it quicker than that?
Speaker 2:Yeah, I mean definitely there is nerves with oh my goodness we're getting there, oh my goodness we're doing this, you know. But I mean everything happens so fast and everything is just slightly different enough from the US that I mean just kind of head in the sand like just got to focus on the one thing I had to do. Like, for example, so the first day we go to their hospital, obviously entire anesthesia machine doesn't fit in the suitcase. So, if possible, there they had two anesthesia machines that worked, but not three, and we had three rooms and we had brought with us a little basically travel sized anesthesia circuit. So this circuit can deliver gas, it can deliver positive pressure ventilations, but you have to be the bag the whole time. There's no ventilator mode Wow. So that was the circuit that I was working with on the first day, oh, my goodness, really, where did that come from?
Speaker 1:I've never even heard of that. Did someone, obviously who'd been on medical missions, know to purchase or to have their hospital buy this thing to take?
Speaker 2:Yeah, they've been using these things for a number of years. I don't know where they got them, but Interesting. Yeah, pretty different I might have a tab.
Speaker 1:You do you have a picture of this? I would love to have a picture of this.
Speaker 2:I don't know if I've got a picture, but I can definitely scrounge up a picture.
Speaker 1:Yes, awesome, give everyone a visual. Okay, so you were in the room, the lucky one person in the room using this red-dub semi-machine thing.
Speaker 2:Right, and I wasn't totally alone either. Just like in the States for induction, you're not going to be alone, they're going to come in and help you out. Kind of the setup of this hospital there's like you're in three ORs and there's windows between the ORs too, and so you're alone. But also, if anything ever happened, you could say hey, and people could come in, you know.
Speaker 1:Yes, wave wildly yeah exactly. What was the first case?
Speaker 2:Trying to remember I know it was pediatrics we did do a lot of pediatric LMAs, a lot of LMA1s and 1.5s. We reused those LMAs, cleaned them, sterilized them, reused them. One of the really unfortunate things about this trip was the IV equipment that we had was really unreliable. That was one of the few things that we were relying on the local hospital's equipment, I think, because you know that was one of the things that we were going to have available. We thought but the IVs were really so terrible that you know, the patients would get one and then it wouldn't work, and so we ended up doing a lot of masking cases.
Speaker 1:Hmm, weird, they just blew.
Speaker 2:It was all kinds of issues like they would blow. They would kink internally. The biggest issue was, I think, the tubing itself was too soft or something, so you'd thread it on and if the patient ever slightly bent their arm it would basically kink and there was no way to unkink because it almost kinked internally.
Speaker 1:Gotcha, wow, yeah, so you're kind of on the fly, adjusting to this lack of great equipment. Yeah, Wow, and how long? How many days were you there?
Speaker 2:We were there, I think, in total like seven days. So we arrived late Saturday night or like basically Sunday morning. Then Sunday we were driving for the first half of the day going to the hospital setting everything up, and first case is Monday morning, did cases all through Friday and I think we flew out Sunday. The following Sunday so yeah, they were about a week with five days of OR time.
Speaker 1:Gotcha, tell us just your day. Like what was the day? Like what time did you get up? Where did you sleep? What did you eat? How many hours were you in the OR?
Speaker 2:Yeah, so slept at a hotel. It was nearby. Then every morning there's kind of two different flights. Anesthesia obviously is on the early flight because we need to set up our stuff. So I think we left every day at six Scott's the hospital about 6.30 with the idea to try to start first cases about seven.
Speaker 1:What do you mean? Flights?
Speaker 2:I get just like two groups, I guess.
Speaker 1:Oh, okay, I'm like you had to fly Okay.
Speaker 2:Yeah, yeah, Cases started at seven-ish and then we really try to fit as many surgeries as possible in every single day. All of our surgeons were really went above and beyond. Yeah, depending on what room you're in ended either like four or five, but some days some of the rooms went a lot longer than that. I think there were some days that there was at least one team there still until like 10 or 11 o'clock at night.
Speaker 1:Wow. And the patients? You know they knew that they were getting surgery this week. They had somehow been selected and pre-opped before you guys got there, gotcha.
Speaker 2:So I'm not super familiar with how that process worked, but yeah, somehow people were alerted beforehand that you know there's going to be this surgical team here and then that was what we were. You know, setting up our anesthesia rooms on Sunday, the surgeons and the surgical staff were basically vetting patients, saw like a huge, insane number of patients who could possibly be candidates for surgery, and then they had to choose from among those who they thought had the greatest need and who were the best candidates. That process was ongoing as well, where maybe Tuesday and this kid just arrived and he's got all these burn scars and this and he really benefit. I know that that was this huge challenge for them to try to decide, because just limited time and limited resources.
Speaker 1:Yeah, I think I well, I have like a thousand more questions, but for the sake of your time, I think I just want to hear maybe your biggest takeaway, what's your most memorable moment? You've had some time to kind of process what you saw and what you witnessed. How has this changed the way you want to give anesthesia in the US?
Speaker 2:I mean, I think on one hand it definitely, I guess, opened my eyes up to how stripped down anesthesia can be and can still be effective. You don't need a lot and you can be flexible. Like that was one of the things that we had to deal with is, we had limited amounts of drugs, so when it was out, it was out, so it's. You know, normally you wouldn't want to use the parody and as a analgesic, but you can All kinds of stuff like that, like you wouldn't want to use ISO for an inhalational induction, but you can. So on one hand, I think that was really interesting, but I mean obviously also the perspective of how wasteful medicine is in the United States. I mean it puts it into stark contrast over there, you know, trying to think strategically about how can I use the fewest syringes possible for this case, like literally the plastic syringe. We're trying to conserve those. You know we're washing our LMAs. And then you know the contrast of that when you come back to the United States and after every case you've filled up an entire trash can with things that you're going to throw away.
Speaker 1:Yeah. Is that unsettling for you now? Or do you feel like yeah, like how do you navigate that disconnect?
Speaker 2:I don't know, it's hard. You know, and that was even something even before this trip I thought was kind of wild. You know, you're at your house to try to recycle your cans and your bottles and then you go to your job and you just produce an enormous amount of waste way, way more than producing your own life.
Speaker 1:Hmm, well, you never know, michael, maybe your future is figuring solving that problem of how to eliminate hospital waste, because yeah, it does really great on you Like. It is really unsettling to see how much plastic waste we have after every single case.
Speaker 2:It's not good, yeah, yeah.
Speaker 1:Well, I am so grateful that you got to take this mission trip. I myself has never been on a mission trip and after all these conversations, I just hope there are so many more opportunities, so many more AAs, caas and AAs students that are like, hey, maybe I might want to do this. Because if I've learned anything so far, it is that it takes someone to push a little bit. It takes someone to be the one who says I want to do this and I'm going to kind of push through some of those roadblocks and those hurdles, and then it also sounds like a lot of what you know a successful career is, which is networking, finding mentors, aligning yourself with people who are also interested in the things you're interested in, and like the next step usually kind of appears right before you if you're doing all of those things. It sounds like that's what happened for you. Michael, I'm so grateful to have heard your story. And how many more months till you graduate now.
Speaker 2:Six months.
Speaker 1:Six months. Well, I hope the last six months are fruitful. I hope you get the job that you want. I'm sure you will, and again I thank you for your time and best of luck.
Speaker 2:Thank you.
Speaker 1:Today I am joined with Alex, who is also in the Case Austin program with Michael. She and Michael actually were the two AA students who were selected to go on this Uganda mission trip, and so I'm really excited to hear Alex's perspective after we learned a little bit from Michael. So welcome, Alex, to the Awakened Inestus podcast, Hi everybody.
Speaker 3:Like she said, my name's Alex. I'm a second year at Case Austin and right now I'm in my cardiac rotation at TMC in Houston.
Speaker 1:Oh, cardiac Wow. So did you get out of the case to do this? You are at the hospital right now.
Speaker 3:I am. I dropped my patient off in ICU and ran down the stairs to come talk to you.
Speaker 1:Well, I appreciate you doing that. I want to hear a little bit more about how you decided to go on this mission trip. We learned from Michael how it was introduced to your class, or the opportunity was introduced. What made you decide to go on this clinical mission trip?
Speaker 3:Well, I really always wanted to go on one. So the fact that we would get to go to Africa and help a lot of people was really appealing. And when I walked up to Ty to ask more about it, he was like you should just come. Like I have a spot, You're just going to come straight with me. It will be great, We'll have a good time and I mean I enjoyed it so much. I'll be back next year.
Speaker 1:Wow, was it just months before you went? Was this a year in the making? When did you find out about it?
Speaker 3:He told us, I believe, around like February, okay, so. I had two or three months to figure it out.
Speaker 1:Wow, were you guys on a break? I didn't ask Michael Like, was it a break in your program or you missed some of the clinical time?
Speaker 3:I missed an entire week of my neuro rotation.
Speaker 1:Oh, my goodness.
Speaker 3:When I came back, I really had to work on that.
Speaker 1:Yeah, yeah, I know it's a lot of trade-offs. Anesthesia school is a lot of trade-offs, If it's not personal life trade-off, it's. You know can be an exciting opportunity like this. But maybe you missed something back home in the it sounds like neuro rotation. I am interested what your experience was preparing for the trip. How much did you know? What were you getting into? Did you just have a couple sit-downs with Ty, the program director, there with you about what to expect?
Speaker 3:It. Certainly I didn't know very much going into it. We had a couple sit-downs. I helped pack a couple of the bags last night but yeah, a lot of it was stuff I was learning as we were getting on the plane, because Ty's been before and so he kind of gave us a little bit of rundown, showed some pictures kind of where we would be staying. But I didn't know what kind of cases we would be doing. I didn't know what all we would have available to us. I didn't even know I'd be staying. To be perfectly honest, I just knew I had it.
Speaker 1:And where were you staying? What ended up being the place?
Speaker 3:So it's a hotel about 10 minutes from the hospital. I don't know the name, but they took great care of us. They had good amenities, they fed us. I felt very safe there, so it's actually a very good place, but I don't know what it was called and it was a rural.
Speaker 1:is this a rural community?
Speaker 3:So Gulu, Uganda is a little. I wouldn't call it rural. It does have paved roads, it has electricity, it has AC in certain places, like our hotel. Not every single home had AC, In fact most don't. And then if you would get about a 15 minute drive out you would be on kind of gravel or dirt roads and you would see all those kind of dirt huts that everybody would live in. It was kind of a little bit more urbanized, but I wouldn't call it a city either.
Speaker 1:Can you describe what the hospital itself was like? Like you know, compared to a building we would see in the US? What size, what capacity?
Speaker 3:It's. The building itself is kind of small. It's several buildings put together with this massive courtyard in between, because that's where people would take care of their families. The hospital rooms one big room with some beds in them. There's not really any kind of monitors to help with the patients. You don't really have any nurses that stay full time on the floor. It's your family that takes care of you. The ICU is the only place that had monitors and had actual nurses, and so none of those areas had AC. They did have some electricity that was never used. The only places that had AC and ample electricity was in the ORs themselves.
Speaker 1:And the ORs were. Were there two ORs? Were there 10 ORs? It sounded like maybe there were two cases going on in an individual OR room. Is that right?
Speaker 3:In some instances they would have two cases going on. But for us we had four ORs out of their sixth total. Each of their ORs actually have an anesthesia machine. They're just not ones that either we could use, or it wasn't calibrated, or they weren't working. So we did have to use some of our own mobile ones. They actually use hollow theme there, for example. So you had to be a little careful about which machine you chose, because that's the only thing they had the connectors for. But we used three of their ORs, the fourth one occasionally for like wounds, changes for their burns, and we had anesthesia machine in each one of those. We actually, for all intents and purposes, were pretty well set up in those ORs.
Speaker 1:And you said you were packing the bags with tie before you left. You were packing medical supplies into these bags, or?
Speaker 3:So each surgeon was responsible for packing their own stuff. So we were packing anesthesia bags, and since there was both Scott and me and Ty, we had to pack three of those back full of anesthesia supplies that were with us on the way over, including our transportable monitors and anesthesia machines. Where did you get those? The transportable anesthesia machines come from medical missions in Kansas. They keep those for us and they are the ones that bought those or had them donated, and so they're used every single year in all of their different mission trip sites.
Speaker 1:OK, gotcha. So the medical missions agency had, I'm assuming, lists of things that you need, as well as supplied some of the basics like an anesthesia circuit.
Speaker 3:Yes, correct. And then most of those things are donated, though, and so one of the anesthesiologists here with she's a great person is amazing, but she kind of knew what we needed to bring, and so she would order things that we needed, and the rest of it was donated, gotcha.
Speaker 1:Wow, can you walk us through the first case you did? Did you know what case you were walking into, what your patient, who your patient was, what you needed to do? Because we heard from Michael that you were basically autonomous, like supervised autonomous.
Speaker 3:Yes, no, we were. So I learned, I think, that they before that had been urology the first day, OK, which was a very interesting experience because I think I was the first person to do an adult that day. So I was the first person to discover our propa-fall didn't work at all and that our machines weren't calibrated for isofloring. I pushed 200 milligrams of propa-fall on this 89-year-old and he still tried to bite me, and a couple of days later, I mean, we were still in the same problems. I pushed 300 on a patient that was even older and he still tried to bite me with a propa-fall which didn't work, and so we were having some issues keeping them under and deep for these urology cases to prevent them from living around. And then the machines for the urology portion weren't working correctly either. So this case was a trembling long, and then I couldn't get the patient to stay asleep, but because the propa-fall can decrease your flood pressure, that part was working.
Speaker 2:So I was giving so much of an elaborate.
Speaker 3:It really made you question that first day. I questioned a lot why I came, but it was great. We figured out all those things. We figured out how to get the CO2 to work. We figured out how to get the blood pressure to actually run A lot of that. Anesthesia was definitely observation, but it was great and at the end of the week we were doing just fine.
Speaker 1:Fit it all figured out, and then you left.
Speaker 3:It was so bad that I had to give paralytic that very first one and then we had to reverse on an LMA. It was just not very fun, wow, but it's.
Speaker 1:OK, we worked it out Makeshift. I think that's what at least scares me, or scares the general CAA who's thinking, yeah, I want to do this, but how would I know that I could function safely? How would I be able to take care of patients? In America? We're so used to the patient moves and the surgeon's like patient's about right. It's this big us versus them dynamic and it sounds like that just can't be possible there. I'm assuming it's some sort of team dynamic. Everyone's in this together. We all recognize that we're struggling with less than great resources.
Speaker 3:Absolutely no. The surgeons and the techs we were with and the nurses were all amazing. We worked together a lot and I tell them, hey, they're probably going to move in a second, just to warn you and they were very patient. So everybody gave each other a lot of grace, especially those first few days.
Speaker 1:Yeah, wow, you mentioned something about the burn patients and Michael had mentioned a lot of that and I was thinking why were there so many burn patients or post-op burns, scar revisions and things that you guys were doing?
Speaker 3:Yeah, I can definitely answer that. So in Gulu, uganda, and most of Northern Uganda in particular, they cook on open flames and so you have this big fire in the middle of their camp and the kids are running around playing, being watched by their older siblings or their aunts and their nieces and nephews while mom's doing something else. Or maybe you're being held in that carrier. That mom's had the little slings and they would fall into the fire. They'd get these big burns, or mom would be carrying something really hot in this pan and she would trip over one and the boiling water would fall on them. For the smaller cases, for the pediatric cases, that's typically what we would see. I know one mom in particular had a 12-day old who fell out of the sling into the fire and we had to take care of that child. But for the older adults some of them were in these kilns and seizures are actually pretty common there. Not 100% sure why, but they are and they would have a seizure and they'd fall into the kiln and get extensive burns.
Speaker 1:Oh, my goodness. So this hospital saw a lot of burns because of the culture and because of the regionality, of what the daily lives of these patients were.
Speaker 3:Yes.
Speaker 1:Wow. So did you know that going in, or did they say, hey, we're going to be doing a bunch of burn cases? There was a warrant.
Speaker 3:We were warned that there might be a lot of burn patients. I don't think I really grasped just how many there would be, though I mean we had that burn room going. It was the latest every single day.
Speaker 1:Yeah, because burn anesthesia is very complicated, like very complex. There's a lot of physiology that goes into it and to do that under resource sounds like a lot.
Speaker 3:Yes, we did not have ketamine, for example, yeah, and so that's a pretty common drug that's used for those surgeries, and I would say all of our patients were rock stars. They did really well.
Speaker 1:That brings up another question. I have so many questions popping off my head. What were the patients like compared to American patients? Like is it the same expectation of not feeling pain? Or talk to me about that dynamic.
Speaker 3:Well, the expectations are different For them. For example, when they were doing ortho cases kind of back to us, their ORs were still running. They were still doing cases over there that weren't part of our mission and those ortho cases would just be spinals. So they'd place the spinal, lay the patient down and then they're awake the entire time. You hear that you're Surgeon's talking over you. You understand them and, which is a very weird experience and something we don't really consider doing here, yeah, and America. And so when they came to us, they were just extremely grateful for even being able to have the surgery when I would they them up and some of them would only get a hundred mics with fentanyl or even Drummer, all you know, that's all they got and they didn't exhibit a lot of pain. They're very stoic people. They weathered it a lot and I I don't know. They were just very grateful and happy to be there. They were all extraordinarily nice. They couldn't understand us, but we're very willing to try and do what we were telling them to do. Even when, you know, we were doing some emergency airways and the patient would wake up a little bit in the middle of that, they weren't freaking out or trying to push you away. They they're very uncomfortable and they're letting you know they're uncomfortable, but they weren't Freaking out to the extent I've had people here In those situations.
Speaker 1:Say more about emergency airway. What, what is this? You were.
Speaker 3:So I did a 12-day old and Down there for a 57% burn and we just I mean, we don't really have the resources to do a 12-day old there, but it was one of those situations where they were going to die whether or not we did anything, and so we thought we were going to, you know, just try and get it in. That one wasn't as much of an emergency. It just took a little bit more effort than we previously expected. The breathing to be mean yeah, yeah, but I think the one real emergency airway we had was we were doing a neck contracture and we are going to to because we needed to do a spin graph and put that in. It was gonna be a long procedure and they have this kind of Outdated, not serviced Video scope there that they don't use because it's just it's not been well maintained because it's just been sitting there for so long and it was a very poor view. But we kind of got a little bit of one and I tried to push the tube through and we couldn't. It wouldn't pass through the vocal cords. So we tried to downsize the tube. We tried the yelling, still couldn't get it in. We switched providers. My clinical director tried to, couldn't get it through, or in a CVR, I just tried to, couldn't get it through, or D setting. We're pushing more sucks and we've discovered that he is kind of bubbling up air on the side of his neck. So at some point we've got some kind of pathway here where we're using air through the neck and we actually never were able to pass the tube when we kind of got a piece of it and you couldn't get any CO2. We ended up doing that case on an LMA because we just needed to breathe for him. Yeah, luckily for us, we could kind of breathe for him in the first few tries, but I was getting harder, so we just placed the LMA and we went with that for this five and a half hour case. You think wow while working on the next, which, yeah, we don't really do that yeah, wow.
Speaker 1:Well I'd say you're ready to graduate if you made it through that, I.
Speaker 3:Tried to place it. I couldn't. I tried it one way, five, and then I went nope, someone else needs to put this in, and so that I let them step in, since they're the more experienced providers and I didn't want to hurt this Mm-hmm, wow, yeah, wow.
Speaker 1:Well, can you tell us just a little bit about what the day-to-day was like? Is it? Is it you know, sleeping, eating, giving anesthesia? And repeat, is there any anything else that happens while you're there on the mission?
Speaker 3:Yes, so we would take turns. I think once or twice I was the late shift so I would stay until the last room is done. But if you were the first, if you got to go home once one of their rooms closed down kind of like the regular shift work we do here and Once those rooms got shut down you got to go back to the hotel, you could change and then a group of people were typically gonna go out and explore and do something else and you could choose to tag along. So I got to go out Into gulu and explore a little bit, I think twice that week while we were still actually doing cases, one of them to go to the burn village that they're building a little bit outside so go to help those patients that are coming into that hospital for room changes or you know the breed men and things like that. And then, after we do our couple days in the war, we get this one day to go to resort and Just kind of decompress for about 24 hours before we hop on our flight home.
Speaker 1:Hmm, and it was a resort Like within a drive distance from where you were in Uganda.
Speaker 3:It was two and a half hours away. Okay, and kind of on the way back to Compare, is that where? Before that I'm no longer clear on how we got in and out of Africa. Those were a Blur those two days there in the two days back. I don't like thinking about those, all that I bet.
Speaker 1:Wow, how has this changed the way you deliver anesthesia now as a student, or how you plan to deliver anesthesia or interact with your patients Once graduated and?
Speaker 3:far more comfortable with observation. Now. I don't look at my mom like I look at the monitors, but when we ex debate patients, you know as a student at, the first thing you look for is like oh, do you see co2? Now I'm like are you breathing? Is your first rising perfect? Are you dumbsturning blue? No, you're fine. You're a lot more comfortable with your observation skills or at least I am now and I can tell a lot more when the patient might be Getting light before there's other signs. That used to be an issue for me, but now I'm like well, that was the only way I could tell if somebody was asleep for a while. So I look for those things a little bit more and I'm a lot calmer in certain situations. Now, yeah yeah, you lose your entitle or your machine stops working and suddenly you're not as worried in the states when that's most likely to happen.
Speaker 1:Yeah, and you graduate this summer or summer of 2024, correct? Yes, I graduated me. Do you know where you're working or where you want to work?
Speaker 3:I do. I'm gonna be working at Texas Children's in Austin.
Speaker 1:Oh my goodness. Well, congratulations, thank you. That's an early acceptance.
Speaker 3:Um, I know a lot of my classmates have already accepted jobs. Wow, I know some of us were looking and I fell in love with pediatrics early, so I already knew where I wanted to go and that's great I didn't talk to them and had an interview and was extremely excited to get it. And now I'm trying to get an additional three months of pediatrics before I graduate.
Speaker 1:Yeah, smart, that's so good. Well, I'm so proud of you. Honestly, I'm really like wowed by your experience and I know this episode is gonna expand so many AA students who Maybe want to bring a medical missions opportunity to their school or they themselves want to go on one, and so it's just so valuable to hear your story and Michael's story. So I really appreciate you taking the time you are in the hospital. I heard like carts go by, I heard Things go by and you stuck with us. So I really appreciate it and I'll be in touch, alex, thank you. Thanks. I hope you loved this special Students Stories bonus episode. Actually, the idea for an episode like this that features AA Student Voices came from my last listener survey. That survey went out to the entire Awake in Dynastis newsletter list. So if you're in that community and you gave me feedback saying that you wanted more focused stories on the AA student perspective, I want you to know that I heard you and I appreciate your feedback. I hope this episode is an example of what's to come. I 100% believe that our CAA community is going to be fueled by the new generation. If you have had a chance to meet any of these AA students, you know how determined and insightful and just incredibly empowered this new generation of CAAs will be, and it's really exciting to think about the future of our profession when it's in their hands. So I want to thank Alex and Michael for being so open and so quickly able to record this episode with me. I really appreciate you both and if you want to join the conversation over and in the Awake in Dynastis newsletter community, there is a link in the show notes to join. What you should expect is a newsletter curated by me specifically for CAAs and AA students once a month going directly to your inbox. In that newsletter you're also going to receive early access to any bonus content, like the episode you're listening to right now. You'll receive updates to any live events that I'm planning for the upcoming year or at the Quad A. You'll also be the first to know of any Instagram lives I'm planning with Process Guests and you'll receive things like listener surveys to really give your unique perspective and help me shape Awake in Dynastis podcast and the community that's resulting from this podcast to fulfill my mission, which is to expand what's possible for all CAAs by hearing the stories of individual CAAs. So I really invite you and encourage you to join that Awake in Dynastis community with the link in the show notes. That's all from me. I hope you have a wonderful weekend and if you're listening to this in real time, let's talk soon.