- Julie Ciaramella, AANA
Updated: Jan 19, 2021
By Julie Ciaramella Senior Digital Content Specialist AANA Public Relations and Communications
From an early age, Brett Fadgen, MSN, CRNA, CFRN, knew he wanted a career where he could help people. He also knew he’d have to do things a little differently. Fadgen, a nurse anesthetist at University of Pittsburgh Medical Center (UPMC), was born without the lower portion of his right arm. As far as he knows, he is the only Certified Registered Nurse Anesthetist (CRNA) in the country with one arm. “I do have a disability, but I’m not disabled,” he said. “I may not do a task the same way as others. I can do it just as fast, but I do it differently.” Fadgen uses several adaptive devices, including a second prosthetic hand specifically for intubating. He engineered that prosthetic by having it manufactured as short as it possibly could be, which improved dexterity. “I have to learn how to do things with one hand whereas others learn how to do things with two hands,” he said. He added that for some tasks, he uses a prosthesis, and for others, like spinals and epidurals, he doesn’t. He stressed that whether he uses an adaptive device or not, his work is just like anyone else’s. And when patients ask about his disability, “I tell them I was born without my right arm and explain that I’m going to care for them just like any other nurse anesthetist would do in their pre-op evaluation.”
What Led Him to Nursing When Fadgen was a child, his grandfather suffered an anoxic brain injury after sudden cardiac arrest and needed constant care. Helping care for his grandfather ignited an interest in healthcare that led him to become a paramedic, first with EmergyCare in Erie, Pa., and then with Ross/West View Emergency Medical Services in Pittsburgh. There were many people who inspired and motivated him, he said, including a CRNA he met during his time as a paramedic. This encouragement, coupled with Fadgen’s own desire to learn more in medicine and healthcare, helped change his life and career path. “There was a nurse anesthetist, Francis Feld, who volunteered at the ambulance service, who told me, ‘You can achieve so much in healthcare.’ This enlightened me to look into becoming a nurse,” Fadgen said. Around the same time, Fadgen’s wife, Kathy, an emergency room nurse, encouraged him to go further in his education. He enrolled in Duquesne University’s Second Degree in Nursing program and went on to attend the University of Pittsburgh’s nurse anesthesia program. As a paramedic, and then later as a flight paramedic and a flight nurse, he said he had “a lot of autonomy going into uncontrolled environments with patients experiencing life-threatening conditions.” That changed in nurse anesthesia school. “I was successful when we were required to sedate and paralyze and intubate patients in the field, but when I got to nurse anesthesia school, my technique was non-standard,” he said. “This raised a lot of concerns as to how I can safely and successfully intubate a patient.” In conjunction with his program director, John O’Donnell, Fadgen declared his disability to the school’s Office of Disability Resources and Services, where he learned about opportunities and accommodations provided to him and the school under the Americans with Disabilities Act (ADA). “The ADA supports reasonable accommodation for individuals with disabilities as long as their accommodations are in fact reasonable to the educational institutions and/or employer. In my case, I was permitted to proceed in the program and I was able to be successful by practicing through simulation labs using my prosthetic devices,” he said. He would go to the simulation lab at the University of Pittsburgh’s School of Nursing and practice on his own before working with multiple faculty members, who ensured the way he performed a procedure was appropriate and safe for patients. He would also have to adapt his prosthetics under faculty supervision. “It had to be two faculty members supervising the way I did the procedure,” he said, describing his time in the simulation lab. “Whether it was endotracheal intubation, nasal tracheal intubation, central line access, arterial line, bronchoscopies—all the procedures in the scope of practice of nurse anesthetists.” When it came to using the simulation lab independently, he didn’t always have access to the lab at the School of Nursing. He would use an airway simulation lab he created five years prior with Feld, the nurse anesthetist who worked with Fadgen on the ambulance. After practicing until he became proficient and felt comfortable doing a procedure, faculty and his program director tested him on his skills. While acknowledging that his experience was challenging, Fadgen said after graduation when he was hired by UPMC, people knew him and knew of the adaptive devices he used in the operating room since he’d done his clinical training there. He would still explain to the attending anesthesiologist and CRNAs how he worked and show his colleagues how he performed procedures. Sharing this information enabled them to work more effectively as a team in the event there was a situation where, for example, they were unable to secure an airway. Helping Others Be Successful By sharing his story, Fadgen hopes to help others—both people with disabilities and without disabilities. He wants to help people understand that even though someone may look different or do things differently, that doesn’t mean they can’t do certain tasks. “I think I can help people figure out ways to be successful, as well as help others that do not have physical disabilities understand how people that may look different or are missing an extremity are able to do everything anyone else can who doesn’t have that physical disability,” he said. He also said by sharing what he has done, he wants to give people the motivation to go after their goals. “I want to help motivate people and tell them that anything is possible,” he said. Fadgen’s own story proves just that.