Voices of Experience 2007

Provider of Distinction:
John Butcher, CRNA

Written by :
Michele Ardigo, CRNA, CANA Public Relations

While in anesthesia training I learned a couple of catch phrases which have stuck with me over the years. Some were passed on to me by wise CRNAs and some I had to learn the hard way. But no matter how such sage learning is acquired-there never is a day that you cannot benefit from another anesthesia provider’s “pearls of wisdom,” or is it- “perils of wisdom?” It seems that if you do anesthesia long enough you will have a couple credos that shape your practice. One I teach any new student is AIRWAY, AIRWAY, AIRWAY - if you don’t have it, nothing else really matters.

I think there is much to be learned by talking to others in our profession. I find the pathway to the road that we all now share fascinating. Having been a CRNA for only ten years, I find my practice is made up of the snippets of experience learned by my own hand, as well as others. I hope this column will serve as a conduit to us “newbies” from those who are the voices of experience.

John Butcher began his path in nursing when he graduated with a diploma in Nursing from Miami Valley Hospital located (of course) in Dayton, Ohio in 1964. He took his first job as a scrub nurse in the operating room at Ohio State University Hospital. This is where he was first introduced to nurse anesthesia. OSU had a nurse anesthesia program. So naturally- one could see a logical transition in Mr. Butcher’s next educational experience - optician school. In 1965, it was the policy of OSU not to permit male nurses into their anesthesia program.

Shortly after starting optician school, he was chatting with a former nursing classmate on the phone. She had just begun a nurse anesthesia program in a neighboring state. She said, “Well, there are no rules against male nurses in anesthesia up here. Why don’t you come for a visit and meet the director.” So John packed up the family for a road trip to Rochester, Minnesota and was promptly admitted to the anesthesia program at the Mayo Clinic. It seemed Mr. Butcher was the perfect candidate for their program. It was Mayo’s policy to accept only diploma nurses. Degreed nurses were seen as unfit for the program as they had “ too much book experience and not enough practical experience.”

Just as Mr. Butcher was completing his second year of anesthesia school, the draft board in Ohio summoned him to the Army. Upon learning he would shortly complete his anesthesia training, they graciously agreed to wait for him. Upon arrival in the Army, he spent as short amount of time in Fort Sam Houston, TX and Fort Carson, CO before receiving orders for Vietnam in October 1967.

Mr. Butcher spent the next year at the 85th Evacuation Hospital in Quoin Yon. The case load was primarily trauma and burns for military personnel, POWs, and villagers. Most anesthetics were conducted under general anesthesia using halothane, nitrous, oxygen, sodium pentothal, and sux drips. Of course, that was if they were operating in the hospital. If one was to be parachuted to conduct a field anesthetic, then the anesthetist would be using his mobile #8 ether hybrink vaporizer modified to entrain air as it’s primary gas source. (I wonder what the pulse Ox would have read?) Back at the hospital, they had the luxury of a BP cuff (no auscultation just watching the needle bounce), a finger on the carotid, and a strong hand for bagging (nary a ventilator.) There were four ORs manned by 5 CRNAs and 2 MDAs. Everybody took turns and worked independently. Since each OR was only separated from the others by a hanging drape, one had to be careful about what was happening next door. For instance, many of the men were exposed to ascarius worms in the jungle. Surgical correction of a perforated bowel would include the surgeon scooping out the worms from the patients’ belly and dropping them on the OR floor. Worms made their exit anyway they could, so Mr. Butcher was not surprised to have one crawling out of a patient’s mouth in the middle of a case on occasion.

Mr. Butcher is forever indebted to another Army CRNA. One week before his tour of duty was up, John was summoned to relieve at another army hospital within Vietnam. It seems the MDA had a substance problem and was immediately relieved of duty, but it would be a week before a permanent replacement would arrive. Since Mr. Butcher was the lowest ranking member on the anesthesia staff, he was to be the relief. At the last minute, one of the other CRNAs named Jerry Olmstead volunteered to go in John’s place. He said it was only fair that John be sent off properly by the group and enjoy his last week with his buddies. On the day Mr. Butcher flew to the States, the OR crew was returning to 85th. They never made it back. Jerry Olmstead died in a plane crash with another CRNA, two Or techs, and two Or RNs.

Once back in the States, John Butcher just wanted to find a nice quiet job, so he moved to Idaho. However, Idaho did not bring him peace in his professional career. The state was having problems with the delineation of practice between CRNAs and physician anesthetists. (Some problems still persist despite time gone by.) After five years of contentious practice in Idaho, Mr. Butcher moved to California in 1973. He was able to enjoy 13 years of peaceful practice until contentiousness raised it’s ugly head again.

In 1986, he was informed that he could no longer be an independent contractor of anesthesia services at his current hospital unless he was specifically “sponsored” by a surgeon. One urologist quickly agreed to have Mr. Butcher as his personal anesthetist. Then one of the ENT surgeons also sponsored him. When the third surgeon signed on to sponsor him, he was fired by the physician anesthesia group.

Mr. Butcher spent the next fourteen years as a vagabond anesthetist. He took locum jobs and traveled around southern California, New Mexico, and Arizona. He came back to Apple Valley, CA in 2000 to work in obstetrics. He is currently employed by Anesthesia Consultants of the Desert as an independent contractor.

After forty years as a practicing CRNA, John Butcher has a couple of his own “Pearls of Wisdom” to share. They are: One- As important as balancing the ego with the spirit, it is equally important not to let your ego get in the way of your anesthetic. Two- Be a Boy Scout- (always be prepared). Three- Be careful when you volunteer, especially in the Army.