July 2015

Message from the DirectorWe are pleased to publish this

summer 2015 edit ion of the Kaiser Permanente School of Anesthesia/California State University, Fullerton newsletter for our colleagues, community partners, friends and supporters. There are many exciting developments and partnerships that are highlighted throughout this publication. We are a Community Benefit Program presented by the Southern California Permanente Medical Group along with our academic partner California State University Fullerton. We are in our 44rd year of educating excellent nurse anesthesia professionals. Our accomplishments reflect the efforts of hundreds of diverse professionals who contribute their expertise to consistently provide the highest quality education and patient care. It takes the efforts of literally hundreds of specialists to make this school one of the most sought after Nurse Anesthesia Programs in the country. Thanks to the continuous support of the many Anesthesiologists, CRNAs, RNs and other professionals, we have been able to achieve such excellent outcomes for the community. We continue our extensive clinical collaborations with many of the finest healthcare facilities in the country.

Our registered nurses are educated and provide care in over 28 facilities throughout California and Hawaii. We also share academic resources with over 20 universities throughout the United States which allows us to provide the most up to date academic and clinical education available. We are proud to provide

over 65,000 hours of free high acuity nursing and anesthesia care as well as volunteer services throughout our community. We are also actively working with our nations’ military via our partnerships with the United States Air Force, Army and Naval

Health Services where we share training and academic resources. Please enjoy this edition of the newsletter. We appreciate the ability to stay in touch with our many supporters and welcome comments and contributions to future editions. The School of Anesthesia shines like a jewel in a setting that affords great value, outstanding quality and great contributions to our community. Thank you all for your continued support and participation in our excellent program. -John Nagelhout, CRNA, PhD, FAAN

SCHOOL OF ANESTHESIA NEWSLETTER

Important DatesAug 21st - KPSA Graduation (Pasadena)

Aug 29th - Sept 1st - Nurse Anesthesia Annual Congress (Salt Lake City)

Oct 2nd - 4th - CANA Fall Meeting (Long Beach)

Nov 14th - KPSA PALS/BLS Recertification (Pasadena)

Find Us Online

kpsan.org

facebook.com/kpsan.org

vimeo.com/kpsan

www

We are extremely grateful for the opportunity that we had to

attend this years’ Mid-Year Assembly (MYA) in Washington, D.C. It was a tremendously eye opening experience and a learning opportunity. We wish every student had the chance to attend. As SRNAs, we felt very overwhelmed and inadequate thinking about meeting with congressman and legislative aids to advocate for this profession on Capitol Hill. However, that feeling of inadequacy quickly dissipated after having the chance

to learn from the amazing leaders of CANA and the AANA. We were able to network with anesthesia providers from all over the country. It became very apparent to us that the individuals, who advocate for the CRNA workforce on a daily basis, are in fact, a large reason why we have such a strong profession. We learned a tremendous amount about legislation and focused much of our efforts on conversations regarding patient safety and access to care. One statement that was reiterated at the Mid-Year Assembly was that they

(the AANA and state leaders) couldn’t accomplish great things without the help of individual CRNAs from around the country. We are very thankful for the newfound knowledge and wisdom that we were exposed to while at the MYA. We hope that all CRNAs and SRNAs will take it upon themselves to donate their time, funds, and experience to further this great work and to ensure that we continue to give our patients access to excellent anesthesia care.

Kaiser SRNAs on Capitol Hill

Educator SpotlightCongratulations to Sass Elisha, Ed.D, CRNA,

recipient of the Helen Lamb Outstanding Educator Award from the American Association of Nurse Anesthetists. The award was established in honor of anesthesia pioneer Helen Lamb (1900-1979), and presented annually to a CRNA who has made a significant contribution to the education of nurse anesthetists. The award recognizes the individual’s commitment to the profession of nurse anesthesia and to the advancement of educational standards that further the art and science of anesthesia and result in high quality patient care.

Q&A with an MDAIf you ask a student or graduate about their

clinical experience at Woodland Hills, chances are, they’ll mention something they learned while working with Dr. Gelpi, who has been a constant at Woodland Hills since its opening in 1986. Not only was I one of those fortunate students, but I have had the privilege of working alongside him over the last 11 years. I had the opportunity to sit down with Dr. Gelpi and ask him to share a little about himself.

Featuring Carlos Gelpi, MDWritten by Jennifer Thompson, CRNA

Jennifer Thompson: Tell me about your educational background.Carlos Gelpi: I went to medical school at the College of Medicine and Dentistry of New Jersey and did my anesthesia residency at Montefiore-Einstein in New York, followed by a pediatric fellowship at Children’s Hospital Los Angeles.JT: What made you choose anesthesia?CG: The truth is….I actually spent an internship year as an OB-GYN and by the end of that first year, I knew it wasn’t for me. So, a close friend of mine said, “Hey Carlos, why don’t think about anesthesia? I’ll take you into the OR and introduce you to some people.” The only thing I really knew about anesthesia up to that point was that we paged them for c-sections. So without knowing much about what I was actually getting myself into, I told my wife we were moving back to New York for my anesthesia residency. (laughing) After a

little kicking and screaming, she only agreed to it if I promised we would eventually return to California, as she was not looking forward to returning to the east coast weather. Fortunately, following residency, they had an opening at Children’s Hospital LA and I was able to keep my promise to her by moving back to Southern California.JT: How did you end up at Kaiser Woodland Hills?CG: I spent a little time in private practice before getting hired on to open up the anesthesia department at Woodland Hills along with two other anesthesiologists. I was pastured for one year at West LA Kaiser while the hospital in Woodland Hills was being built. So the three of us started in April of 1986 with only 3 ORs and built the anesthesia department from there.JT: What piece of technology or innovation, in your opinion, has had the biggest impact on the development of anesthesia practice during your time as a provider?CG: As far as technology is concerned, I would have to say the first thing that comes to mind is the pulse oximeter. I remember in private practice, we had 20 ORs and only two pulse oximeters. We would try to get to work as early as possible to get one of them for our room. Next, I’d say the LMA and most recently the Glidescope have become tremendously useful tools. From a pharmacological standpoint,

By: Jeff Kupfer, Alexis Arbeit, and Megan Baerny

Congratulations to our 2015 CSUF graduates!

propofol has certainly been the most impactful. (showing me a small scar on the palm of his hand) This is from mixing a vial of Pentothal that completely shattered in my hand back in the day. Other things that I believe have made a big impact are the institution of name alerts, time outs and verifying surgical sites. All of the things that address patient safety have made quite a difference as well. But I’d say overall, pulse oximetry, propofol, LMA and the Glidescope; those four things have really revolutionized the practice of anesthesia.JT: Students really enjoy working with you. Tell me about your teaching philosophy.CG: I really enjoy teaching; I think it keeps you sharp. The SRNAs come here very prepared, interested, and motivated to learn. Students ask questions that make you think and force you to analyze things that have become routine. I like to continuously engage the student and challenge with the “why” questions. I address many clinical skills by asking why providers do things a certain way. If the student can give a valid rationale for performing a skill a particular way, then I let them do it. Even if it’s not how I would choose to do it. If I teach a student a new technique or clinical skill, I validate that choice with reasons why it’s safer for the patient and/or more efficient for the provider. Even more importantly, I remind myself that the student is here to learn anesthesia, and if they leave at the end of the day without learning anything from me, I’ve done them a disservice.

JT: What kind of things, outside of work, do you enjoy doing?CG: I like to target shoot. I’m very interested in history; reading and learning about history. Primarily ancient history...Greek, Roman period is what I enjoy tremendously. However, most recently, I’ve been studying chemistry.JT: Chemistry? Why?CG: Well, my daughter recently made a drastic change from studying criminal law and is now taking nursing prerequisite classes. She came to me one day and was concerned and crying about having to take chemistry. So I told her, no problem, that we’d do it together. Now, I hadn’t done chemistry in 40 years and here I am walking around the hospital, carrying my chemistry book to study in between cases and on my down time. It’s not as easy as I thought it would be though. (laughing) It was a tough course! But she got an A, so it worked out well!JT: Tell me something that most people may be surprised to know about you.CG: Well, I’m probably the only person around that solely writes with a fountain pen. It was not until last year that I actually got a smart phone. (laughing) I was still using a flip phone until it broke and no one had the parts to fix it. I’m very traditional like that. I also collect and restore old lanterns, Coleman style lanterns. It’s a hobby of mine. (laughing) I sometimes think maybe I was a moth in a past life because I’m attracted to the heat and light. But I enjoy going to yard sales and swap meets to find them

and then I restore them myself.JT: If there was one piece of advice you could give to anesthesia students, what would it be?CG: I would tell them that they have an incredible advantage as students because they get to watch others provide anesthesia. I don’t have that opportunity. I don’t get to see how my colleagues place epidurals or manage an anesthetic, but they do and they should use that. I tell them to take clinical tools from each person they work with and begin to put them all together to form their own practice.

“Dr. Gelpi is a calm and collected provider who is knowledgeable, approachable and treats the students with respect. What I liked most about him is that he always made you feel like a welcomed member at Woodland Hills, and not just a student.”

-Michael Forster, Class of 2015

Warm Fanta is my new favorite beverage. Not because it tastes

good, but because the people of Migori, Kenya happily spend an entire week’s wages to purchase and share the soda with those who come to help their people. In July of 2014, I had the privilege of traveling to Migori as a member of a Kenya Relief surgical team. It is a trip that has changed me both personally and professionally. Just nine short weeks before I stepped off the plane in Nairobi, I got a call from a dear friend and colleague who said a spot had opened up on a medical team going to Africa. After a brief text exchange with my husband, the decision was made. Looking back I am

glad I only had nine weeks to prepare. I had no time to be nervous. Traveling with a short-term medical missions organization was something I always wanted to do but I had never progressed to the planning stage. Now there were no excuses. A spot was available and I had enough notice to request the time off. The organization sent a checklist of tasks to be completed. There were vaccines to be administered, anti-malaria prescriptions to fill, and forms to be completed. I must admit the document requiring a notary which instructs the Kenyan government on what to do with my body should

I die in country, did give me pause, but it was too late to turn back now. After seventeen hours of flying and six hours of driving over poorly maintained roads our team arrived at the compound. The heavily armed guards and electrified fence securing the compound did once again give me pause. However, the smiles and the sounds of the orphaned children, who live in Brittney’s Home of Grace, singing and exclaiming “Jamba” reminded me that is was a privilege to be there. The first morning we toured the compound and that afternoon we went to see the clinic and check out the equipment we would be using, which was surprisingly much better than I

expected. When we arrived at the clinic there were over seventy-five people, of all ages, waiting patiently. They knew a team was coming and they were hoping to be seen. No one pushed, shoved or attempted to cut to the front of the line. No one complained about the wait or the comfort of the waiting room (which was the ground outside). They are a people with little and appreciate everything. Gratitude of that magnitude is both humbling and motivating. At 0600 the next morning we arrived at the clinic and began working. There is one operating room with two operating tables. Space is tight. We lost power fourteen times that first day. The first loss of power lasted over an hour and the surgical incisions had already been made. You recall what you learned in simulation and you figure out ways to make things work. As I was preparing to extubate a patient, we once again lost power and with the power loss, I lost suction. I asked for a bulb syringe. The circulating CRNA improved on my idea and attached a red rubber catheter to the end of the syringe. The improvised instrument worked

beautifully. Sometimes the power loss would be partial and we would only lose the use of our anesthesia equipment. The case would continue with TIVA and hand ventilation. The circulating CRNA, which is the CRNA not directly assigned to one of the two operating tables, would stand at the end of the OR tables and use the battery operated

blood pressure cuff and pulse oximeter to take vitals on the lower extremities, alternating between the two patients. We operated for three days. No one on the team wanted to take a break and we wanted to work until we could no longer stand. Some of these people had been waiting for years for a chance to have surgery and there was no guarantee they would be seen this time. It has been a year and I still cannot talk about (or type about) the pure joy radiating from the smile of the last patient of the day when she hopped up on the table. She was excited because she knew she would not have to wait for months and hope to be able to return when the next surgical team came to help. I will return this July and it is my hope to return every year. I encourage you to go. Friends, colleagues and total strangers who learn you have taken two weeks off work and spent another week’s pay to travel to a third world country for the privilege of working long hours in sub-standard conditions will be impressed with your sacrifice. But that is because, if they haven’t been, they cannot comprehend the value of warm Fanta.

“One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.” -Francis W. Peabody

Alumni Spotlight - Becky Ashlock, CRNA, DNP

www.kenyarelief.org

“The True Measure of Any Society can be found in how it treats its most vulnerable members” - Gandhi