CRNA Inspiration

Below are words of wisdom intended for CRNAs and taken from a quote compilation by Michael P. Dosch, CRNA, PhD, of University of Detroit Mercy Graduate Program in Nurse Anesthesiology.

On Anesthesia:

What emergency treatment is best administered by ear? Words of comfort. -Abraham Verghese, Cutting from Stone

…for the secret of the care of the patient is in caring for the patient. -FW Peabody 1925, Cutting from Stone

Just as English Missionaries discovered when they came to India, there was no better way to carry Christ’s love than through stupes and poultices, liniments and dressings, cleansing and comfort. What better ministry than the ministry of healing? -Abraham Verghese, Cutting from Stone

It is often the second mistake, coming in haste to correct the first mistake, that does the patient in. -Abraham Verghese, Cutting from Stone

Sound Nursing Sense is more important than knowledge, though knowledge only enhances it. Sound nursing sense is a quality that cannot be defined, yet it is invaluable when present and noticeable when absent. To paraphrase Osler, a nurse with book knowledge but without sound nursing sense is like a sailor at sea in a seaworthy vessel but without map, sextant, or compass. (Of course, the nurse without book knowledge has not gone to sea at all!) -Abraham Verghese, Cutting from Stone

All things are always on the move simultaneously… One has to do the best one can, but he is an unwise man who thinks there is any certain way of winning this war… The only plan is to persevere. -Winston Churchill

You were in a hurry [and made a mistake]? Son, those boys in the oak-paneled offices downtown don’t know the meaning of the word, “hurry”. Jim Bloomfield CRNA

You will get into trouble, when you talk yourself out of doing what you know you should do.

It is important to learn from your mistakes. It’s even better to learn from others’ mistakes. -Andrew Teich

Experience is a great thing to have, but you have to suffer a little to get it. -Lloyd Carr

On Anesthesia Education:

Character is both formed and revealed when we are tested, when we are forced to make decisions under pressure. That test can either make us stronger or it can highlight our weaknesses and crack us into pieces. -Bryan Cranston

One of our professors described a lecture as “a mystical process by which the notes on the pad of the lecturer pass on to the pad of the student, without passing through the mind of either.” -John Cleese

Lack of boundaries invites a lack of respect. -Gerard Hogan

Old men want to feel that the experience which has come with their years is valuable, that their advice is valuable, that they possess a sagacity that could be obtained only through experience-a sagacity that could be of use to young men if only young men would ask. -Robert A. Caro

In college you want good grades, a great social life, and sleep. You can have only two out of three.

It doesn’t matter how heavy the last straw is.

Look at the patient.

Some people have eight years experience. Others have one year of experience repeated eight times.

There is no learning in the second kick of a mule. John Pina Craven

“The schools remain the repository of hopes, the guarantee of security for our profession” –Agatha Hodgins.

Only the laundryman knew the true extent of their fear. John Pina Craven

When I went to graduate school for nurse anesthesia, we were told, “Don’t get married. Don’t get divorced. Keep the distractions to a minimum. Devote yourself to it.” Devote? I wasn’t planning on joining a monastery or nunnery. The church-like mental image I had of Devotion did not seem to match the educational journey I was beginning… After a time, I realized that you can get through it either by casting yourself into it whole-heartedly (devoting yourself to it), or could do just enough to get by, or could even be dragged through kicking and screaming. You got through in each case; but devoting yourself to it was a lot more pleasant. Win, lose, or draw, I slept better at night- knowing there was nothing more I could have done to keep my patients safe…. It can be the worst two years of your life; or you can make it the best two years.

[Mike] Barwis is a firm believer in pushing the body beyond what the mind thinks it can do. “When we look at what we’re trying to achieve, it’s not about needing something or wanting something — you have to work to get it; that’s the bottom line,” he said. “If you want something, you have to pay the price to be there. We never try to weed anybody out, but some people don’t want to pay the price… Working as hard as you can possibly work to achieve a goal is not for every person and that’s OK if that’s the decision they make. I can’t control that. You’re going to see kids fall out of there because they don’t want to pay that price. The kids that do will be successful. Bo (Schembechler) coined a phrase, ‘Those who stay will be champions’.” Angelique S. Chengelis / The Detroit News May 5, 2008

Work beats talent unless talent works.

Everyone can be prepared at a doctoral level. But if they cannot maintain an airway, they will be out of a job by noon on Monday. Sandy Ouellette

Clinical expertise is formed by good judgments. Good judgments come from bad experiences.

Novices see only what is there; experts see what is not there.

To a hammer, everything looks like a nail.

When you’re in a hole, it’s time to stop digging.

When I was young, Dad told me about a man who used to bang his head against a wall, because it was so nice when he stopped. -John Cleese

Honesty without compassion is brutality.

I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.

You’ll always have trouble with a two-headed dog.

People judge you not by your abilities, but by your choices.

Some bridges are pre-burned.

What makes you think you can’t do anything that any human has ever accomplished? Einstein had about 1500 gm of brain tissue, just like you…


You hate to come, you hate to stay, you hate to leave.

His greatest strength is his greatest weakness.

Talk low, talk slow, don’t say too much.

The essential elements of an anesthesia education are: knowledge, skills, attitude, humbleness, and fright.

This course is dedicated to the idiotic proposition that you can be taught the fundamentals of Organic chemistry, Inorganic chemistry, Qualitative analysis, Quantitative analysis, Physical chemistry, and Biochemistry all in one semester. The odds against any of you passing this course would be staggering to contemplate if there were any time for contemplation. However, there is not. Get out your notebooks. Max Shulman The Many Loves of Dobie Gillis

It’s not his job to remind me, it’s my job to remember. Michael Crichton

It’s all hoops– but in anesthesia school the hoops are smaller, they’re made of concertina wire, and they’re on fire.

I’m just walking down the hill slowly…

The following quotes, compiled by Mark Lema, were published in the 2002 January and July issues of the ASA Newsletter and were also included in Dr. Dosch’s quote compilation. 

Anesthesia Aphorisms:

If you can’t manage the surgeon, you have no business managing the anesthetic.

Friends come and go, but enemies accumulate.

You can either lead the disease or let the disease lead you.

There is a direct relationship between the number of tattoos and the propofol dose.

There is an inverse relationship between the number of tattoos and the tolerance to regional anesthesia.

There is an inverse relationship between a surgeon’s ability and the frequency that he/she asks for more muscle relaxant.

There is no vital organ in the body that cannot be reached with a #14 needle and a good strong arm. (From The House of God)

There is no condition that cannot be made worse by surgery (and/or anesthesia).

It’s easier to do it right the first time than to do it over.

Beware of colleagues with no sense of humor—they are not very bright and will blame you for their errors.

Sick people die! (use in place of self-flagellation when a negative outcome occurs).

Every patient is a “preop”—it’s just a matter of figuring out for what!

The patient isn’t bleeding dopamine!

Practice is the best of all instructors.

Numbers are tools, not rules.

If you can feel a pulse, don’t panic.

Fibrillation is a sign of life.

The better you are, the luckier you become.

Be wary of patients whose risk exceeds their ejection fraction.

Treat the patient, not the monitor.

Prevoznik’s Laws of Anesthesia

  • Never anesthetize a patient who isn’t there.
  • Compromise, though not desirable, is permissible with all but patient safety.
  • Death can be deferred but not defeated.
  • It is much easier to add (drugs) than to subtract (them).
  • Never argue with success just because you can’t explain it.
  • No block ever fails, some just have to be supplemented more than others.
  • Fifteen minutes spent preoperatively with a patient is worth 15 mg of morphine as a premedicant.

Better to plan than to react!

The less the indications, the greater the complications.

Ability and voice decibel level are inversely proportional.

Everyone eventually gets the reputation they deserve.

There is no such thing as too much I.V. access.

Perfect anesthesia can’t overcome poor surgical technique.

Regional anesthesia is like a lazy cheetah: it can be spotty and may not work; general anesthesia always works.

Planning for emergence begins with the incision.

Airway trumps anything.

Don’t poke a skunk.

Even a blind squirrel finds a nut once in a while.

All substances are poisons; there is none which is not a poison. The difference between a poison and a remedy is dosage. –Paracelsus (1493-1541).

Nothing is as inconspicuous as good anesthesia, nothing so obvious as its absence.

You never have to apologize for a good result.