Awakened Anesthetist

What To Do Before You Do a BIG Thing

• Season 3 • Episode 50

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As a CAA I know you have faced many make or break moments. But, how did you make it through? When I reflect on my near 2 decades as a CAA and all the challenges I have overcome, I can see a framework develop as my "pre-game" ritual if you will. Of course your hard thing  is not always about professional challenges- weddings, babies, coming out journeys, first days, last days, and everything in between. CAAs are uniquely pursuing their best lived lives and that generally means we are leaning into discomfort and out of the status quo. As I near my next big thing (speaking at the AAAA 2024) I am reflecting on the routines and mindset shifts that have supported me through all the BIG moments of my adulthood. In my 4-part framework I discuss my unique mindset around preparation, the finesse of practice, my "trust and letting go" phase, and the power of my confidence boosting ritual. While this framework doesn't guarantee the exact outcome I desire it always allows me to do my best and I hope it does the same for you! 


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Mary Jeanne:

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. Welcome my fellow Awakened Anesthetist and any AA students who are listening, maybe some prospective AAs who are listening. Welcome to AwakendAnesthetist podcast. I'm really happy you're here.

Mary Jeanne:

I had this idea for this podcast what to do right before you do a big thing pretty spontaneously. I'm really recording this impromptu a big thing pretty spontaneously. I'm really recording this impromptu. I was not expecting to record, but this podcast really is about me trying to create the community and the resources that I really wished I had about six years ago, when I was really reconsidering my career in terms of who am I outside of the CAA profession? I love giving anesthesia, I love being a CAA, but I found myself after about a decade in the career feeling sort of unfulfilled and I just didn't feel quite right and I wasn't even sure what that even meant. And our career is so unique in what it gives us and the situation it puts us in and I just wanted other CAAs to have that camaraderie of like okay, we're moving all through this together and this is what it feels like to be us and this is what we do in these situations, and I just couldn't find that community. So today I had this idea to share, I guess, this framework that I have found myself repeating over and over again as I've been doing hard things, I'd say probably for the past five years, sort of stepping out of my comfort zone, stepping outside of just the box that my career had kept me in. Like I thought being a CAA had to look a very specific way and I thought this was really the exact type of resource that I would have wanted to stumble upon, you know, six years ago, and so I decided to put it out into the universe.

Mary Jeanne:

Also, admittedly, I work today and we had a really long lull between cases which I work at an extremely efficient surgery center and I'm telling you we have like seven minute turnover time and it's barely enough time to use the restroom or grab a snack. And for some reason we just got off and we had some big cases that went long, some big orthopedic stuff, and I had like an hour and a half to just sit and think. And this episode title and outline just sort of came to me and I use those handy dandy scrub cards. Have you ever written on those? I'm sure you have this one's Medline, but you know when the scrub asked you to spin with them and you grab that card and then you get to keep it and write whatever you want on it. It's been different things for me over the years, but now I seem to be just writing down my creative thoughts and like ideas like oh, I want to make a podcast episode about this or that, and so I have a stack of them, truly. So I'm working off an outline that I had printed and written on one of those cards to make this episode.

Mary Jeanne:

So what has sort of surfaced is this framework of the four things that I do before I do a really big thing. I'm going to give you some examples that have popped up in my life, in particular like my life adjacent to career. And then currently my big thing is that in a week, exactly one week, I will be in front of about 800, 900 CAAs and AA students delivering a lecture, a workshop, on substance use disorders in the CA profession. And then, just a few hours later, I'm going to be on stage doing my first live interview, which has been a dream of mine and, in particular, a dream of mine to do on the Quad A stage, and also I get to interview our current Quad A president, danny Massaros. And so it's just a lot. It's a lot of things that I've really wanted to do, a lot of big things that I'm going to get to do here in about a week, and there's been a lot of lead up to it.

Mary Jeanne:

And when I look back on some of the other big things I've done and maybe some big things that you're considering or about to do as you're listening applying to AA school, having that first interview for school or your first job interview, or, you know, the Sunday scaries, like the Sunday night before going to the first day at a new rotation, your second year. Oh gosh, I just can be taken right back to like that anxiety. But there's some things that I've done and I do want to tell you all four things right up front, just so you know where we're going, and then I'm going to give you some examples and give you some more details of what I mean. So the first part of the framework is the preparation phase, so to prepare. The second part is to practice phase. So to prepare, the second part is to practice. The third is sort of after you've prepared and practice.

Mary Jeanne:

I have always reached this point where I just have to say that's enough, I'm going to trust I've done what I can and just sort of let go at that point. So a trust and let go, portion. That's number three. And then number four is the little ritual that I've really done since AA school, and I'll tell you about that. This little ritual that I do right before I do a big thing, so literally the seconds before I go to do the big thing, be it my first IV at a new hospital, you know as a first year student, or walking into the anesthesiologist office to quit my first job. I have found that I do this little ritual and it really helps. It's really really helpful and comforting to settle my body. So I'll walk you through that. So the four parts of this framework are to prepare, to practice, to trust and let go. That's number three, and number four is this ritual. So let's dive into number one.

Mary Jeanne:

Prepare Might seem sort of obvious. I do believe you can underprepare and therefore underperform, and there's a fine line because a lot of AAs and AA students are perfectionists and type A and it can be really difficult to know when you've prepared enough to know when you've prepared enough. And so I put a lot of stock and weight into a very slow build. But consistent preparation. I've tried it, of course, lots of different ways, waiting till the last minute, doing the whole cram session. As I lean into more of my creative brain. I have found that doing small bits consistently has gotten a better outcome. And I can look back and I can also see that's what I used really my second year of AA school. So when I'm preparing I'm really looking to put in short bursts of consistent energy. So for my lecture, my workshop and meeting with Dani in order to prepare for our interview. I really started months ago so it's April of 2024, and I probably started the PowerPoint for my lecture maybe November of 2023. And that's also when I met with Danny, who I'm going to be interviewing, and we chatted and I created the storyboard and I've just like sort of thought about it slowly over the course of these many months and then, as I got closer, of course I had more, larger chunks of time to work on this PowerPoint and to think about my interview with Danny. But still, it's really this building of a consistent preparation that gets me where I want to go, and it's very interesting because I know exactly who I learned that from, because I had not always been like that.

Mary Jeanne:

But when I was a sophomore in undergrad, I actually transferred to a new school and I transferred at a part where everyone I knew at that school already had a roommate. We were living on campus, and so I ended up just getting placed with a random person, and that random person happened to be Megan, who became a really good friend. And Megan was an education major and a lot of her work was project-based like a lot of their finals happened to be project-based, and so what I didn't realize is that I was about to enter into a master class on how doing a little bit of work every day gets you so far ahead of the pack that Megan would use her planner. She would put months in advance these big projects she had to do or her big essays she had to write. And I watched Megan work on these things months in advance, little by little, and as we all approached finals or mid-semester or whatever and we had these big projects or big essays due, megan was like out partying and having a good time while the rest of us were stuck in the library because we had waited to the last minute, and she was just so relaxed when it came to these big moments and I just really was in awe of that.

Mary Jeanne:

I had never seen someone master that slow, consistent preparation so easily. It just came so naturally to her and it's funny because we still are friends, we still talk and actually last year I was able to tell her about witnessing her do this like type of preparation and how it really changed me and I kind of, you know, gave her some gratitude and thanked her. She was like I have no memory of doing that Like that's news to me. I just think that's funny, that this thing that was so intrinsic to her really changed my life, like changed the way I approach really big, important, hard things for the better. And she has no memory of doing that but she's like, yeah, I guess I do do that, but I'd never considered that you'd be watching me or like that was a thing that you know was odd or different. So it was just funny.

Mary Jeanne:

But my preparation, yes, is slow, consistent over many months. I much prefer that and it actually is easier to fit into my life. Of course you have to, you know, be able to plan early enough to know when a big thing is coming, of course, and so that time frame tends to shift, but I still, no matter what the time frame is, I never wait to the last minute. I am always doing a little bit at a time so that it's not a heavy push right at the end.

Mary Jeanne:

And then the other piece of preparation that I found myself doing more recently that has mattered a lot is I take some intentional time to really envision what's a success for me and what's a failure, and to really write down or journal, or just you know, imagine, sit there, meditate, whatever you're comfortable with, or for me it often happens on walks and it will kind of pop into my head and I'll just sort of play out what's the best thing that could happen or what am I hoping to happen. You know, let's say at the quad A and then the opposite, what's the absolute worst? What if I get booed off stage? What if people are just totally disengaged and nothing lands and you know it's just a torturous 90 minutes? And then, once I've really played out those, the worst case scenario always seems less likely, like that's probably not going to happen on a lot of levels. And the best case scenario, or what my successes are, help me build whatever I'm trying to create. So I know the ends of where I'm wanting to go and it's much easier then to find my path there once I know.

Mary Jeanne:

Like for this workshop, I would love to walk away with a list of names of people who are also passionate about CAA wellness and creating more resources and helping CAAs help ourselves as it pertains to wellness, substance use in our profession, burnout, you know, looking at things like disconnection and loneliness in our profession and how to really get at some of these root causes so that our profession can be perhaps the most well anesthesia profession Like. That's my big goal, my big dream for us as CAAs, and I would love to find people who want to move along that path. That is my best case scenario that in the preparation process, along with that consistent input of energy to actually do the work to prepare is most of the work leading up to a big thing, so you can take that and shape it as you need for your own big life event. Certainly, everyone's lives are unique, but maybe consider what preparation might look like for you, what has felt good or has worked in the past. We are creatures of habit and it is really reassuring to fall back on something that's worked before because it helps your brain sort of not go into that negativity bias, that worst case scenario. And I found that really, really helpful for me and I can see how.

Mary Jeanne:

Even when I was an AA student so my second year of AA student I had this epiphany that every day I was going to try to learn one thing that I didn't know before that day. Every day I was going to try to learn one thing that I didn't know before that day. So it was way too overwhelming for me as a second year student to even consider trying to just like read chapters in books to study for the licensure exam. But every day something came up when I was in the OR that I didn't know, be it like a name of a drug or a question. I was asked and so I just made a point to just pick one of those things, One of the things that I got called out on. It was always easy to remember those and go home and just make sure that I knew whatever that thing was well enough that I could teach it to someone else, and that really, really helped me.

Mary Jeanne:

That really snowballed for me when I was a second year AA student and I found that when I got to the exam I had done all the studying I really needed. I kind of, you know, did some crash courses, of course, a few days before as well, just, I think, because we all were doing that, but I probably didn't need to. I probably had absorbed enough of the information over the previous 365 days that I got the score I needed, and so it's really pulled through for me. So, yeah, I just hope that maybe hearing that applied to a life of a CAA helps you use that for your big thing. So that was preparation. That was the longest one.

Mary Jeanne:

The next one is practice one. The next one is practice. So it is very important to put your mind and your body into the type of environment where you're going to have to be doing the hard thing as much as you can. So for me, I have certainly practiced speaking my lecture in my workshop and leading people through it like fake, led people through the whole 90 minute things several times and I will probably do it for another, maybe two or three times and then stop as I get too close. So I'm a week out, so I'll probably do it, you know, the next two or three days and then kind of stop and let things simmer, which I'll talk about. But practicing is really important. I think it again goes to say that you can be underprepared, you can be underpracticed and practicing absolutely helps us perform better.

Mary Jeanne:

When we are at a heightened state, doing this hard thing or this big moment, you know I'm thinking of like having a baby or walking into work on your first day as a new grad, practicing, and like mentally running through, even if you can't get yourself to like as close as it's going to be, like you can't duplicate the experience. You can just mentally run through what the day is going to look like. Actually, now that I'm saying that, I'm remembering that I tell a lot of first year AA students that just run through the case in your mind, truly like don't just kind of, you know, fake, do it, or, oh, I'm going to do that, and that is like, really step by step the night before, walk your mind, your body through the steps of, you know, taping the eyes and then ventilating, and then turning on the gas and then turning off the gas and all the things, because it really really does make a difference. There's a lot of psychology and science behind that, but practicing in the environment as close as you can to what it's actually going to feel like for me makes a huge difference. And I've done that leading up to every big thing, and I've certainly done it leading up to this big moment that I'm about to have here in a week at the Quade. So the third piece is that at some point before every big thing and it's usually, you know, just a couple days before or maybe the day before I have this overwhelming sense of I've done enough. Any more is just driving me crazy. It's not actually going to help me. And I enter into this. I'm going to just trust that my preparation and my practice has got me where I need to be and I'm going to take the next day to just kind of let go of the outcomes and let go of my obsession to control exactly the words I'm going to say and how everything's going to go, and just really trust myself and trust my preparation.

Mary Jeanne:

Last year when I spoke for the first time at the Quad A I was the first lecture on the first day of the Quad A I had never spoke to a room full of people. I've spoke at church several times, but that's like 100 people and something about doing it professionally or in front of your profession at least for me, was really, really meaningful and I wanted to appear an expert and I wanted to be. You know, I wanted to appear an expert and so I practiced, and practiced, and prepared, and prepared and then about three days before I was like I'm just I'm not going anywhere anymore. I can feel myself just like almost like an obsession, and I just got really honest with myself and just called it quits in terms of like the preparation and just took a couple days to relax and to tell myself that you know, I've done a great job and sort of start like that positive talk and like that positive energy going into the big event. Yeah, and I can see myself having done that before the birth of all three of my kids. I can see myself having done that before studying, or like before actually taking the licensure exam to be a CAA, when I was about to graduate.

Mary Jeanne:

You know, at some point my body almost tells me like you need sleep more than you need to prepare, and so I've really been much more intentional about that as I've gotten older and have seen that pattern where my body says like this is enough, you've done it well enough, you can stop now. And I just choose to listen to that, even though it's a part of my brain that's like no, no more, more, more, keep going. I really choose to lean into that trust and let go phase. You know, at some point a couple days or whatever whenever it happens it's unpredictable, but at some point I'm like watching and waiting for it and I haven't got there yet. I'm still a week out. I still feel like I need to practice more and prepare more, but I do trust that it's coming. So maybe there'll be a follow up and I'll let you know. But that is number three trust and let go.

Mary Jeanne:

And the fourth one is the little ritual I do before I truly moments before I go and do the big thing. So the ritual involves the main clinical instructor that I had at Case Cleveland when I was an AA student. His name is Dave Zagorski. I actually just had to look up his last name again on the case website because I couldn't come up with it. But as soon as I saw Zagorski I was like oh yes, of course he was our main instructor circa what? 2006, 2007, when I was a first-year AA student and I remember we were doing the first IVs you know, you like practice on each other back then I don't know if that's still allowed Practice IVs on each other. And then he was giving us sort of like tips and tricks and I remember that he said someone told him or one of the things he tells students is that right before you go to do your first IV or like before you have some sort of performance moment, if your hands are shaky like, go find a little corner to duck in, ball your hands up into two fists and just squeeze as hard as you can for about 30 seconds and you know something about exhausting the release of acetylcholine and like your neuromuscular junctions are kind of like paralyzed for a second and you can't you know they can't reactivate for a little while.

Mary Jeanne:

I don't know that he really explained it, but so I'm going to stop trying to explain it. But basically it helped my hands not be shaky and helped other people's hands not be shaky as well, and so I was like, oh, that really works. I'm going to do that and so truly for the entire first year of doing IVs with people, I would like quick run behind like the nurse's station and do like the hand fist thing, get my hands to just like kind of relax. I also take a couple of deep breaths, which I don't know that I intentionally did that, but now I certainly intentionally do, after I've connected a lot of the science that I've learned through my meditation practice and like all that learning about your parasympathetic system and your vagus nerve. So the fist thing, some deep breaths, and then I give myself some serious, positive talk.

Mary Jeanne:

I am not ashamed to say that I really build myself up. I don't know if I pick this up from sports, like from playing basketball or where I got this. Nothing comes to mind. But I am very much like Mary you got this, you did like an amazing preparation, like you're the one that's meant to do this, you're going to do a great job, like I unabashedly give myself a ton of props and it really helps. It really, really helps me.

Mary Jeanne:

And so putting those things all together has become this little ritual that I can do. You know, takes just a few moments, and I can do it right before I walk on to the big stage, or to walk in front of the new patient to put their IV in, or right before I do the A-line, or, you know, right before I walk into the operating room, and I know I'm going to be meeting a new clinical preceptor that I don't know anything about. And so all these moments have had this ritual preceding them. And so now this ritual really puts my body into this relaxed state. It's like, okay, I know we're about to go do a big thing, and so this ritual starts this cascade of events that builds me up to a place where I can confidently enter the room or walk onto the stage. It's been very, very interesting to see that develop from 2007 to now and to really have that as a through line in my journey of what do I do right before I do a big thing.

Mary Jeanne:

So I hope this framework helps. I hope hearing it from another CAA maybe helps it land in some new ways. Maybe you've heard all those things before but you're like, oh, now it makes more sense because someone who I can relate to has just said how it impacts their life. And, yeah, I really actually hope to make more episodes like this. I've got some big ideas, I've got some big plans, but it all truly starts with this Quad A talk that I'm giving.

Mary Jeanne:

In exactly one week from when I'm recording this, it for sure feels like the next phase of my life will begin after this Quad A talk. I will have put onto the table something I'm really passionate about, something that I want to help move forward for our CAA profession, which is building a way more robust wellness, well-being resource center, building a profession that values that, or finding out if my professional colleagues value that enough to move forward in a way that I think is going to be meaningful, and I don't exactly know how it's going to shake out. I do know that I'm prepared and I've practiced and I'm almost at the point where I want to trust and let go, and I know that right before I walk on that stage I'm going to be doing my little ritual. I know it's going to be a really big sort of heavy topic, deeply personal topic for a lot of us and maybe a new topic for a lot of us as well, and so there's only 90 minutes. I can't, of course, take everyone on the journey I would like to with this topic and why there's so many facets of it that I think impact our community, but I'm hoping by the end of it we all feel like we are more connected to each other. There's gonna be lots of time to talk. There's gonna be a lot of time to do some small group discussion, to do some big room discussions and, yeah, I'm just excited to put it out in the world and have you guys all see what's sort of in my heart and what I am really most wanting for our profession and just to start figuring out where my talents overlap with your talents and with your voice and my voice, and like who's going to do what and some of the logistics, and just start things moving forward. So that's the lecture I'm giving on Friday morning and then, if you are at the Quad A this year at 4.15 on Friday April 12th, I will be doing the first live podcast interview for Awaken Anesthetist. It's going to be with Dani Massaros, live on the main stage at 4.15, and we'll be doing a process episode Again. Don't know how it's going to go. I'm pretty sure it's going to be really fun and I know that this community is going to be rooting for Dani and rooting for me, so I'm actually not nervous about that one as much. So I hope this episode was helpful. I hope it was a new perspective.

Mary Jeanne:

If you loved this episode, what you can do that really really makes a difference is to share this episode with another CAA in your life or AA student Tell them why you loved it. Tell them why you think they're going to love it. Your life or a student tell them why you loved it. Tell them why you think they're going to love it. That actually helps way more than leaving a rating or review, which helps a lot too. You can also do that, but our community is so small and we could honestly touch almost every single person in this community by just sharing the podcast, so I appreciate your help in doing that and spreading the message of Awaken Anesthetist. And if you're at the Quad A, I will see you in a week. Hopefully you can come up and say hi, we can have a chat. And if I don't see you there, I hope we can talk soon.

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Mary Jeanne Roberts, CAA

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