Transcript
Speaker: Apparently I'm chatty. April is too. Under anesthesia. Or at least when we're waking up. I am certain you cannot say something that I have not heard already. I bet. This is On Call. This would be really cool to just wear scrubs all the time and you don't have to think about what you're going to wear to work. That is awesome. We're here to answer your questions. We can sit down and discuss them.
Speaker: Wait, I got to go. I'm on call. Wait, you're on call? i thought I was on call.
Speaker: Welcome back, everyone, to another episode of On Call with April and Alicia. I'm April. Alicia. I'm Noelle. And I'm Sarah. And we have guests. We have guests in the call room. Not just one, we have two this time. it's crowded in here.
Speaker: yeah. It's great. So, um Noelle and Sarah, do you want to go ahead and let ah the audience know who you are? Sure, I'll start. I'm Noelle Morse. I'm the Chief Anesthetist Officer here for Sound Anesthesia.
Speaker: And I'm Sarah Garber. I'm the Associate Chief Physician Officer for Sound Anesthesia. Thank you. We're so excited to have you guys. We are. And I'm excited to talk a little bit more about why we have these guys in the call room with us today. But first, April, but first, what's happening in the world?
Speaker: Are you middle? You know, I don't. It's the same old. It's fall. That's what's happening in my world. that And I know that it's your favorite season. fall. But I love it. well No, our our first hurricane in the Atlantic Basin, by the way, um we are having. And that would be my biggest story. But I know we're tight on time.
Speaker: You can hear how tired I sound. i don't feel like I barely slept a week. I worked night shift last night. And um you're a trooper for being here for night shifts. Thank you. I, um, we had 23, think 23 admissions between. Oh my God. yeah It was, uh, it was insane. And I was delusional, probably the way I sound right now. And about 3 AM, m I get up out of my, see, I'm documenting and I stand to go, like, I'm going to go see a patient and I'm just trying to get my mind right. I'm like, okay, I'm going to this room in the ED because they all start, all the numbers start looking the same. You start walking back into the same rooms.
Speaker: And I'm staring and I was like, I'm seeing something. There is something staring at me. and I'm like, no, no. Okay, sure. It was a mouse.
Speaker: There was a mouse sitting in this basket of food. there were like gravel bars and all this stuff. And it was, swear this thing was on its hind legs. Guys,
Speaker: i have I have mouse trauma from my like young adult life. Like my first apartment was infested with mice. And of course I was like that really cool teenager that was like, I don't need my parents. um And I got like the worst apartment ever, but um I did. I had this mouse trauma and I screamed. So one of my colleague, um Diana, she like runs in, she's like, are you okay? And I was like, there's a mouse in here. And she's like okay well where did it go i'm like i don't so focus on the mouse and she basically should have just said, hey honey, like change your diaper. We have 23 patients to see. But I don't know where this thing went.
Speaker: And I spent the rest of the evening swearing I heard it everywhere. Swearing I was like, like I just heard it again. i just heard it I like had this whole email drafted in my brain that I needed to send to the executives and to let them know about the hospital. Like it was insane. And then by the time I got back to the hotel,
Speaker: You guys know when we travel that you hear everything. I swore up until probably 10 this morning, i heard a mouse everywhere and i could not I could not sleep. I feel like Ace Ventura, like when he was in that little psych hospital right now. Like I should be sitting here in a tutu with my hair all over the place because that's how crazy I feel because I think I'm hearing a mouse.
Speaker: So, um, this is actually probably a good transition because i need to be sedated and like i need put down right now. And I was just thinking, April, how funny is it that we're talking to an anesthesiologist and anesthetist today? so i that's that's my little dumb travel yucky mouse story but that's quite the story that makes me think of when my kids are like mom there's a bug and then I run in and it's gone but they can't get into bed because they're like it's in my room and I'm like oh my god I have no idea where it is It's simultaneously in your shoe and like in your shirt at the same time, but there's only one, but you know, like it is already multiplied. That's how it goes in my mind. I'm like, there's Teenage Mutant Ninja Turtles and Master Splinter now, like inside Diffositions Lounge.
Speaker: And I'm like, when I go back tonight, I'm like, this is going to be insane. So um more to come on the next episode. Can't wait to hear more. Of Alicia versus Nature. Yes.
Speaker: Oh my gosh. I could be its own podcast, Alicia versus. Yeah. See, you guys, are there any, pal are there, are there any animals that just freak you out?
Speaker: Snakes. I'm a snakes kind of person. And my sister has pet snakes. So it it kills me to go to her house. I'm like, are they all like put away and preferably hidden where I don't have to actually like. they all like And how do you know if they're missing? If she has that. Oh gosh.
Speaker: That's a nightmare. on long tira how about you? Anything? You know, I'm more of like a slimy kind of thing, like a frog or something, anything that's sort of like looks or feels like it might not be pettable, like freak me out a little bit. If it's pettable, you know, it's got some redeeming qualities, but the sliminess factors, definitely not for me. Yeah. Yeah. And then, and work and work and pest don't mix for me. So, um, yeah, anyway, Oh,
Speaker: oh Yuck. I'm going to go with Noel and the snakes. i'm not ah I'm not a big fan of snakes. oh Yeah. All right. Well, every time we have a guest, Sarah Noel, our tradition is that we do a Let's Break the Ice session. So a little icebreaker, let the audience get to know you a little bit better. So we're each going to ask you guys a question. um Alicia, you want me to go first or you want to go first? Yeah, I'm going to go first.
Speaker: All right, I'm going to break tradition. and We're not going to go food this time. um But we are in October. And so Halloween is coming. So as you think back to your years of trick or treating and Halloween dressing up, what was your favorite costume costume as a kid like this one or a teenager?
Speaker: Can it be as an adult? Oh yeah, as an adult too. yeah I guess we still dress up as adults, right? we to yeah yeah Yeah, no, mine actually is from last year. so my kids and I, and my husband, we we had the opportunity to go to Disneyland and they have like a little Halloween party and I'm not a Disney type of person, but we went anyway.
Speaker: And our family dressed up kind of Alice in Wonderland. So my husband and i were Tweedledee tweedled d and Tweedledum. And we won't we won't discuss with you who I know, who was who.
Speaker: But it was it was a ton of fun. And I don't often dress up as an adult, but there you go. We had a great time. That's awesome. I love that. All right, Noelle. That's awesome.
Speaker: Oh, gosh. So I have had two. So pretty cool costumes. My in-laws actually have a huge Halloween party every year. And so the first year I went as Cruella DeVille, which was very well received, which um was super fun. um and then kind of along the lines of Sarah, um I went as Dorothy one year and had like borrowed my neighbor's dog and had with like a live prop of Toto and things like that. So we love Halloween. Awesome. So was the rest of your family the rest of the Wizard of Oz cast?
Speaker: No, it's kind of crazy. my okay Yeah, my husband was like an Incredible Hulk or something and the boys were little minions. Nice. Awesome. I did get my husband one year. We did... um Woody and Jesse as adults in the party. enough But I've been trying to get my family to do like a family, you know, all of us and my kids veto it every year. They're like, no, we're not doing that.
Speaker: So it's not cool. They're like, no, yeah, no. and They can't go get their um their photos with like their mom and dad. All my kids are all about, like, you can't mess up on aesthetic. You can't mess up on aesthetic. And I'm like, whatever. I'll pay for your aesthetic, child. Exactly. I'm funding your life. That's right.
Speaker: Okay, i I'm going to flip it a little bit on its head, a little bit more of a serious question. um What is something that someone has passed down to you guys not something material, but a lesson or a value or a way of living that you hope one other see in you and that you hope to pass in others or down to others.
Speaker: Oh, that's very serious, Alicia. I know. Trying to tap into those big brains you have. Yeah.
Speaker: I guess mine would come from my grandmother who told me to always be true to myself, but, and um treat others as you would have, want to be treated by them. And I know it's super simple, but it is something I try and live by. And I think it's important, especially in like medicine, where I really do look at each patient as a family member and how would I want my family members taken care of if they were in the shoes. Yeah.
Speaker: like catch Yeah, that's such a great one. i'm I'm thinking a little more along the lines of kind of professional mentors. And I had um early in my leadership career, have somebody sort of instill upon me to assume positive intent in everything we need. in everyone, and no matter how difficult it may be, um that that's always a great way to start um ah a process, a conversation, or an interaction is assuming that everybody is bringing their best self, um myself included. and And that's something that I try i try to bring to the the things that I do.
Speaker: I love that. And I specifically asked this question just on the heels of having worked last night and how quickly can be consumed with the mouse, right? Or the 23 admissions and all of the things that are ahead of us and forget um to be something like mentally present. But it was something I was thinking while I was sitting with a patient, like, what what would I want her to say about me when I left here? That I was distracted, that I was... worried I was going to go over my time because i would already working over, you know, all these other things or that this person maybe picked up on something or listened or, you know, valued my life.
Speaker: um So anyway, I love those answers. And I love that you both brought it back to medicine because that's kind of where I was going. Yeah, awesome answers, guys. um And I think I'm with Noelle too. I always remember, you know, when we're kind of discussing, collaborating on cases, like how do we advocate for patients as if they were own family members. So we're super excited to have you guys here with us today. And so I want to give each of you a few minutes to... Tell your story, you know, tell, you know, we, we know that you're both here with us at sound and leaders at sound for the anesthesia team, but tell the audience just a little bit about yourself and um your story here at sound or before whatever you want to share. Well, yeah, whatever it is you want them to know about you.
Speaker: So no, well, we'll have you go first. Okay. um So, well, I've been at town for about six years and I guess I'm one of the longer term providers here in the anesthesia service line. um But about me as a person, I'm a mom of two two boys and two fur babies, um wrestling mom. So all of those memes are true. I am the crazy woman screaming at the side of the mat. So I try to yeah you know control that a little bit. Yeah. Exactly. Short time, short time. um
Speaker: So a lot of my time was spent with them, but now they're older. So they're a little bit um out of the house. And um for fun, i have this really great group of ah women that I go hiking and camping with. We just got back from a multi-day camp out in Montana and we hit Wyoming at the same time. we did the Grand Tetons and then um spent some time in Jackson Hole in that Yellowstone. So it was really cool. And we look for different places to go every year.
Speaker: Kilimanjaro is on my list. So hopefully we start training for that soon. Mm-hmm. But I did Rainbow Mountain and Machu Picchu in Peru and things like that. So I like to be outside when I'm not in the hospital. I just like you all. I spend a lot of time in the hospital and traveling for work. So try and really reconnect.
Speaker: with the family. Prior to Sound, I've been giving anesthesia for a really long time. Seems like ah since the dark ages, really. um So, but prior coming to Sound, I worked for some or other organizations, but I feel like I've found my spot here. I think we're building something really great anesthesia. And tell us what you do, Noelle.
Speaker: Oh, so I'm the chief anesthetist officer. So um with partners like Sarah, and then we have a Dr. Emil Engels, um we oversee the clinical practice of our teams across the country. So we are ah bringing an innovative approach to building anesthesia models so that we can help our hospital partners, both um financially, but ah drive efficiency and um excellent patient care, and really kind of bringing anesthesia up into the the current century because I think it was stagnant there for a little bit yeah yes and you still go into the OR and or CRNA as well yes ah yes it's true I am practicing it um OB is my specialty and uh I love any shifts that I get to do there so I can commiserate to like the call rooms and uh nights Alicia with things uh in the call room because I work a lot of 24-hour shifts and always interesting like what is that crazy right did I just see that or not
Speaker: right Do I really want to look under the bed or are we just going to try and ignore this? like things these Probably don't look. Yeah. yes So sorry. Yeah. So I still am um practicing and um balancing a little bit of everything for us. The woman that does it all, I will say when we talked, I think earlier this year,
Speaker: You were, i think, on the road with 28 days in one month. I was like, oh, my gosh, you guys are bustling. We are. I'm actually across the coast. So, i you know, I live in Connecticut, but I'm here um with our go live in Yakima. So actually, Sarah and I are in the same time zone for the first time in a long time. So it's been interesting.
Speaker: Awesome. Awesome. Sarah, tell us about you. Yeah. Well, thank you. So I am also ah still practicing. So I'm an anesthesiologist and practice. I'm currently located in the Portland, Oregon metro area. So also West Coast time with Noelle. Noelle and I ah We're in the same room yesterday, but I made yeah i made my way back home ah for today. So I am originally from the Midwest and born and raised in the southern part of Missouri, although as we like to call it where I grew up is Missouri. That is 100% correct. I am from the part of the state where it is Missouri. um And did my medical school and training in the Midwest and then met my future husband, current husband, when I was training in Minnesota. He is a native Pacific Northwestern born and raised in the suburbs of Seattle. So we have been out here on the West Coast for...
Speaker: Gosh, 20 plus years. And i I won't say he, well, now I will say he we're we' are a little bit older ah than some of the other fellow parents. We still two elementary school kids, but my husband is headed to his 30th high school reunion this weekend. Wow. It sounds so long, but it's really not, you know? but i not I feel like I am still a child, right? i just yeah like that High school graduation was not that long ago, but when he said the number, i was like, that cannot possibly be true. It's so funny you that because I think a lot where I'm like, No way. 20, that wasn't 20 years ago. Like just even 9-11, I'm like 25 years. Right? 26, whatever it was. And I was like, no, it wasn't.
Speaker: Then i'm like, my gosh, I'm that old. It's incredible. Okay, sorry. I know. I mean, I've celebrated my 22nd birthday like a lot of years now, if you're like, but I still celebrate it every year. Exactly. That's are right. That's right. You're only, yeah, you're only as young as you feel. And I i feel that every day feel older every day, but I still don't feel as old as that number says.
Speaker: um But yeah, so I am the associate chief physician officer on the anesthesia side. So I still practice clinically, but I'm also in the crusade with Noel to help bring access to anesthesia, um,
Speaker: to hospitals and patients across the country. um i know, not part of necessarily part of my my opening, but we all know that getting access to healthcare care in all aspects is absolutely difficult um from so many ways. And just being a part of sound anesthesia and being a part of being able to bring anesthesia to to places where wait times have been longer and to open up Access has really been um an important part of why i joined sound, but also why um continue to work so hard ah to help to help our programs grow and to help our practice grow because we're really we're really doing good things for our communities.
Speaker: you guys are. It's great. It's fun to watch you grow, too. I love hearing all the stories about all your new adventures. So it's fun. Awesome. Well, um we're excited to have you guys today. And, um you know, for the audience, we really wanted to bring Noelle and Sarah on to to talk a little bit about, you know, anesthesia and you kind of how you prepare for it what to expect, some new things, you know, that were coming out. The one that I actually experienced personally and actually asked Sarah about it a couple of weeks ago when I saw her in person. So I think we'll go ahead and jump right in if you guys are ready.
Speaker: Why don't I start off April, if that's okay. yeah um I'll start off and either you both can answer one, whoever wants to do it is fine. um I think about this in context of every time I walk into a patient's room, not every time, but you know, the first question we start getting asked while we're just trying to get a history is like, well, I don't have insurance. Or they'll start saying like, well, like what is this? How's this going affect my insurance? And I'm always like, I'm not looking at your insurance. When I walk in the room, I'm looking at everything else. But, and I wish patients knew that.
Speaker: that we're not coming in and determining our care when we first meet them based off of their insurance. But what is something you wish your patient population knew? If that's in the OR setting, you know, wherever you are providing your services, what's one thing you wish your patients knew about anesthesia before they came in?
Speaker: That's such a good question. the The thing that first comes to my mind is that we will be there with you the whole time. Oh, that's a good one. With Anna? Yeah, because sometimes folks think that you know we're only there at the beginning or at the end because that's the only time that you think about us. That's the only time you see us on your on the the medical drama shows. you know you stepping out, but, but the anesthesia folks, your anesthesiologist, um, on occasion, but your CRNA, um, is with you the whole time watching your blood pressure, your oxygen, your heart monitors, your breathing, making sure you stay safe and making sure you stay comfortable the whole time. Um, and that we're the ones that are there, um, uh,
Speaker: just with you one-on-one, making sure that everything's going really well from the sort from the surgical standpoint until you're waking up and until you're feeling um ah you know with less nausea, with with less pain in the red recovery room.
Speaker: Yeah, I do love that. Yeah, because I think that the biggest time you remember them is like counting back to like what and we get to like eight from 10. You know, and that's like the last time we remember seeing you. But yeah it's usually or you're telling them some story about how you like, trust me, you'll never be able to put I'm really hard.
Speaker: You're like, shut up, Alicia. Good night.
Speaker: That's so true. And most patients really only meet us for a short period of time. um So I think they feel like that's our first interaction with them without realizing like we've we've prepared for their arrival. We have read through their history. you know We've looked at their surgery and um all these things. So we're prepared for them well in advance of that quick conversation that they may or may not remember after we give them some you know some relaxing Versed advice. Um, and I guess I wish patients would know that's okay to be nervous. Like that's a normal reaction. So any anxiety about that's completely normal and it's our job to help you feel more comfortable.
Speaker: That's right. If you're not a little, yeah, if you're not a little nervous, we worry about you a little bit, right? We don't, you know, like, We do this every day. This is like a day at the office for us, right? Like we, you know, we are comfortable in these settings, but gosh, if, if you come in as a patient, if you're not like a little bit, if you've not got some questions for us, we do worry a little bit about you. We want to hear those good questions. That's right. Yeah. It's funny that you say that. I think it's, oh, go ahead. and Sorry. I was going to say, that I have a little delay, so I apologize.
Speaker: No, you're good. um I was going to say, it's funny that you say that, Sarah, because I think as patients, like we we as a patient perspective, you don't know that the team is like talking about you right when you're not in the room. And I recently had a procedure and my surgeon didn't even know that I was a healthcare provider. like I just purposely didn't say anything because I sometimes feel like you get treated a little differently. And then after the fact, it came up and she was like, we were all wondering why you were so calm like in that room. Yeah. And then free app room. Like they were like, Oh my God, why is she so calm? Like is some, is she okay? And I was like, Oh yeah, I was fine. I knew exactly what was happening. So it's interesting that you say that. Go ahead, Alicia. I never tell people either ever that I'm healthy.
Speaker: It makes them nervous, I think, more than that. It's either that or then it becomes the challenge and it's like, okay, i'm just I just need to go to sleep. um But um for yeah one thing I do want to point out though, when you guys talk about expanding anesthesia, like to even access and you know what you're doing with the service line now, I think what's fascinating for me to see, you know, 10 years ago when I had a patient that needed a procedure or something that was pretty difficult and we needed anesthesia's assistant, it was like, you know, anesthesia consult. And we were lucky depending on where we were, if we could get that.
Speaker: Now it's interesting because i see the the anesthetist or the anesthesiologist coming in and they're following up with the patient, even post-op, like they've come to the rooms before the the staff is able to access them. And we now see them as part of the floor management team at times too, which is just really neat.
Speaker: um It kind of speaks to the growth that you guys are talking about, you know, executing now. So I like that. Yeah, wait that also, I think, speaks to to my heart as an anesthesiologist, too, is we're not just the ones in the operating room. Like, it's really important for us kind of before your surgery to understand what's going on. Like Noel said, like, we we know a lot about you before we meet you the the few minutes before. But we're also really invested in how you're doing afterwards. And we know the things that we participate in, the pain medications and and the management of your anesthesia, the management during your surgery really makes a difference for your recovery.
Speaker: Yeah, absolutely. Absolutely. All right. Well, along those lines, um as you think about you know patients coming in for surgery, sometimes it's for the first time that they've had anesthesia. So what can patients do prior to surgery to better prepare themselves for their upcoming surgery and anesthesia?
Speaker: um I think the first thing is to always follow the instructions that you are given from your surgeon. Yeah. Listen, write them down. Hopefully we're writing them down. Someone who is calling you from the pre anesthesia clinic or from your surgeon's office or from the hospital or surgery center, um, follow those instructions on things like blood thinners and things like, um, when to stop eating and when to stop drinking. Cause those things are pretty important for us. Um, if, uh, you know, we, we need you, we don't, have you ah starve yourself for before anesthesia for fun. We do that on purpose. We are re we never want anything bad to happen to folks who are coming to visit us. um We don't want anything in your stomach. We don't want anything from your stomach to come up and go into your windpipe when you are, when you're having your surgery. And that's why we, we really, And those rules where you can't have anything to eat. And so that's one of the important things to to to make sure you're following before you come visit us. Sorry, Noelle, I cut you off, please. Yeah, no, that's okay. That's all things I would say. um Absolutely. And then really trying to come into surgery as healthy as possible. Right. So if you do have chronic conditions, try and manage them appropriately leading up. We can certainly help with that when you come in. But the healthier you are coming into surgery, the better. And I think the biggest thing is please be honest with us. um You know, if you smoke six packs a day we want to know. Don't hide it from us. You know, if there's you know, yeah you had a bender last night, like, please tell us ah we we can work with that. But we just need to know. so that's the biggest thing, I think, for us.
Speaker: Yeah, and it I think one of the other pieces is um keeping your regular health conditions. If you're on medication for something, diabetes, high blood sugars, high blood pressure, just making sure that you, if you have time, if your surgery is planned out in advance, making sure that those conditions are under good control. um i think I would... ah Always again, my, my training comes back to me. If you can quit smoking, even for a day, please quit smoking. Um, I don't want to be giving medical advice on the podcast, not to be, um construed as medical advice, but please stop smoking. I think that's safe medical advice to give because I would give that to pretty much anybody I talk to. Yeah. And even even for a day can be helpful um both during your surgery and in your like recovery. As soon as you can, please stop smoking and please stop smoking ah ah it's ah as far away from your surgery as you possibly can.
Speaker: Yeah. Well, and as a kind of a follow-up to what you guys mentioned in terms of your instructions. So, you know, what if somebody is going to get surgery that day, but they wake up and like, for some reason forget, oh my gosh, I can't eat. And they take a few bites of food, you know, one, what should they do there? And then two, I've been seeing some changes with, in terms of liquids, like and being able to have clear liquids, like closer to surgery versus, you know, that fasting after midnight. So can you talk a little bit about that?
Speaker: Yeah. Again, be honest if you ate, just be honest with us what you ate, because there are some things we can, you know, maybe put your surgery a little later in the day. Maybe what you had was okay if it's more clear clear liquidy. And um the the guidelines have changed. It used to be, you know, nothing after midnight and then it was eight hours. And now it's about two hours before surgery for clear liquid. um But still, you know, certain procedures have changed. preps and things like that. So really going back to what Sarah said earlier, follow the instructions that that they give you pre-op, right? Because that that they will not steer you wrong. And, you know, we want you happy and healthy and in your best self. So definitely if if you can have...
Speaker: clear liquids up to that two hours, they'll let you know. um In some cases, we're giving carbohydrate drinks and things like that. So it's really important to just follow the instructions that you get prior ah prior to surgery. But be honest with us. Tell us. like We've seen it all. we We don't mind. We just want to be able to take care of you safely.
Speaker: Yeah. Yeah, that makes sense. yeah I've seen some of those, you know, like ensure clears, things like that. And my understanding is that it's to kind of help you afterwards, right? With your healing. Is that what you guys would say?
Speaker: Yeah, like we, the strict, you know, no eating and no drinking, we've come to realize that starving patients reduces their ability to heal their wounds well, reduces their ability to recover from their surgery, um coming in dehydrated,
Speaker: In general, I think we've learned now that everybody's carrying around their 10 gallon bucket of like stanley out of but that hydration is important. Um, as I'm, as I've got my, you know, hydration here as well. but Keeping folks hydrated with carbohydrate drinks, making sure folks um have the right amount of protein in their systems before surgery. All of those things we recognize actually improve healing, which is um really great, and improve folks' outcome overall in their recovery from their surgeries. So yes, there's lots of good evidence behind those things, and um always be following those instructions that your that your surgeon's offices are giving to you. Awesome.
Speaker: And does it, I'm going to just one off here, but does it, does it vary? I'm guessing it varies for procedure that you're doing, but um I'm starting to see things institutionalized now where it's, you know, and if NPO after midnight, but clear is still five. If we suspect the procedure will be before noon, but it's like, what procedure, you know, what, it like for ah us clinicians, what's some good guidance? Is it talking to you, talking to the surgeons? Yeah.
Speaker: what would you recommend on the clinician end when we clarify that NPO status? Yeah, definitely ask us because it is surgeon surgery dependent and sometimes surgeon dependent too. And then we look at like what the patient conditions are, any comorbidities, because that may change our plan. You know, there's a lot of diabetes, decreased gastric emptying and all those things, we we take all that into consideration, but just give us a call, um you know.
Speaker: Or PhD clinics. A lot of patients go through that too. But if you're, yeah if it's last minute or emergency case, you know, it's got to go. So we make some, um, safety accommodations for that, but for sure. Well, no, like how you string this because I think, and Sarah, speak to this as well.
Speaker: Most of our patients, at least and in our practice, they're not routine. So we're we're getting that complex, you know, a severe AS who needs a TAVR, but also needs a colonoscopy because they have an upper GI bleed. We've got to give them something. And they're also hypotensive. um So We have to consult with you. And we talked about this earlier in our beginning of the questions about how you become a you have always been a part of the team, but now you've become such more of a visible member. what is What does collaboration look like for that not routine patient, that complex patient that is coming in and we need to collaborate with you?
Speaker: Yeah, that's a great question. I think for me, that means that the surgical team, the hospitalist team, everybody, the patient included, knows what the risks are.
Speaker: um a lot of these procedures that from folks that that you folks are taking care of are not elective procedures, right? You can't wait six weeks to come and get your upper your upper endoscopy for bleeding. Right.
Speaker: And we still need to do that case. and And, you know, there may be high blood pressure, low blood pressure, sepsis, um blood transfusions ongoing. the The discussion is really around what am I thinking? What are the risks specific to this patient?
Speaker: is this patient high risk for a cardiac event? um Because we know that they've got, you know, chest pain at rest. And how do we do our very best to optimize the patient knowing that that's still a risk? and what is it riskier to not do the procedure?
Speaker: Is it riskier to do the procedure? Do we need to do it today? Do we have a day to optimize the patient? do What other optimizing things can we do?
Speaker: Do we need a blood transfusion? Do we need to correct electrolytes? And it's just really having that open conversation of like, what am I thinking? And what are you thinking? um because sometimes we don't know how urgent the procedure or emergent the procedure is and our surgical colleagues can help us with that. And sometimes our surgical colleagues don't understand the concerns that we have around specific um patient conditions.
Speaker: Right. Makes sense. Yeah, I mean, it's, you know, I think us all collaborating as a team is really the the best way to get those patients the best outcome. So, um okay.
Speaker: Well, and we talked a little bit earlier about, you know, the fact that we see you guys for a short period of time, you know, like ah Sarah walks in says, hi, I'm Dr. Garber. I'm going to give you anesthesia today. And then in five minutes, we're in the OR and then we're sleeping. Right. So in that five minute conversation, um what can you think of that, you know, patients should like, is there any like questions they should be asking? Like, how do they optimize that time with you guys? Is there any risk factors that they should make sure that they tell you about, you know, those kinds of things?
Speaker: Absolutely. um ah ah Come with some predetermined questions, maybe if you you have anything, write it and write them down because once you get start talking face-to-face to us, a lot of times people will forget or the family um member afterwards will say, oh, we forgot to ask you kind of about this. So um write them down ahead of time. I think that really just helps jog their memory to really optimize those couple very valuable minutes that we have with them.
Speaker: We definitely want to know if you or your family have ever had a problem with anesthesia in the past. um That's a huge red flag for us. And it could lead down a cascade of different preparation for that for that case, but definitely um any anesthesia issues. And then we want to know about your history. So, um you know, do you have sleep apnea? Do you have chronic conditions such as diabetes, hypertension? um You know,
Speaker: do you Do you have sleep apnea? Should you bring your machine with you? You know, do you have your machine? Let's talk about what that's going to look like in the recovery room and things like that. Do you use your machine? Do you use your machine? Exactly. If not, one will be provided for you. exactly Yeah. And, you know, GLP ones now. So things like that. So just write down your questions for us and we're going to have a lot of questions for you too.
Speaker: Okay, so Noel, you something you said made me think, maybe we could talk a little bit more about this, complications from anesthesia. And you you say that, and what I find interesting is the very first time I heard that, did anybody in your family have complications with anesthesia? I said, no. Well, one of those complications was like post-op nausea and vomiting, which I didn't realize i was supposed to say every member of my family does. Also, we don't close our eyes when we go under anesthesia, apparently. So that was another thing I was supposed to. supposed to see When you say the word complication, I think, do we stop breathing? Are we allergic to it? like So tell talk to me, Sarah and Noel, about complication. What do you mean? And what are important things that patients or us as providers, even that are coming to to have you take care of us? what
Speaker: what What are those things that you're looking for? And and maybe a why behind it.
Speaker: Yeah. So ah as far as um ah have your has your family ever had complications from anesthesia? So there's one important medical condition that's really specific to anesthesia and the medications that we use to. ah ah it's called malignant hyperthermia. It is uh, basically an allergic reaction to inhaled anesthetics and to succinylcholine. And it, um, runs in families. And that's why that's one of the big reasons why we, we ask about that. And when I ask patients, um, I usually ask if their family members have had allergic reactions to anesthesia and if anyone in their family has ever had, uh, high
Speaker: severely high temperatures because it does cause um elevated fevers during the anesthesia. And a lot of times families, because it is such a severe reaction and because it is runs in families that if anyone in your family member in your family has ever had it, you'll have ah a medical alert band. know And so, yeah, so lots of times people know it. um ah Other things that that we're asking, things about complications, nausea and vomiting. if If motion sickness runs in your family, it is higher risk for you to have nausea and vomiting after your anesthesia.
Speaker: And that is something that that we we prevent the nausea and vomiting best by giving prophylactic medications, medications to prevent nausea and vomiting. And we have a whole toolkit, um as you guys are aware, too. There is... And coming at the nausea and vomiting from multiple different um types of medications works the best. And so when we ask that question, yeah, if everybody in your family throws up during anesthesia or everybody in your family throws up in the car ride, let us know. We can help with that. Yeah. help with that
Speaker: Do not suffer in silence. clean Yeah, that's right. um And then the other thing I think about when I think about complications of anesthesia you know, overall, modern anesthesia, and this is sort of comparing anesthesia today to anesthesia 50 years ago, 100 years ago, anesthesia today is is safe. Like for um majority of patients, the complications are things that happen commonly. It's the nausea, it's the vomiting, it's the sore, scratchy throat. Some folks can get some body aches. um
Speaker: Severe complications or major complications from the anesthesia, things like problems with your heart or problems with breathing or with your airway, those things are extremely low risk. And that risk is really related to how sick you are before your anesthesia. So if you've got severe cardiac problems, if you're one of maybe your patients who is septic in the ICU on a ventilator, who's having an emergency surgery, that is higher risk.
Speaker: for complications of anesthesia. um But if you're a healthy human who is not on medications, who or is on medication, but your blood pressure is really well controlled and you're coming in for hernia surgery that's not an emergency, your risk of having complications, major complications from anesthesia ah is is very, very low. um And those are all the things. That's why we ask you a million questions. That's why pre-anesthesia clinics will ask you a million questions because we're trying to stratify all of the the risks um ah that that you come in. So we can have real conversations with our patients about, you know, there is risk that goes along with everything. like I sometimes tell folks, um there's a risk for getting in your car and driving to the anesthesia, to the hospital to get, right? We just we just don't make you sign a consent for that one, right? like like like like and And it can sound scary, but it's one of those things where it's overall really safe. And if the benefit of having your surgery and fixing your total, you know, you're you're getting a total knee replacement or getting your hernia fixed, if that and that improvement in your life, um that that benefit outweighs the very, very low risk of having complication of anesthesia, then that's the conversation we're having. Yeah. Yeah. And they always have their concierge anesthesiologist or anesthetist sitting with them during thoseing those moments while they're asleep. So that's that's a beauty part of that as well. Noelle, did you have anything you wanted to add there?
Speaker: No, I think Sarah covered that pretty well. Thank you, Sarah. Sorry, too much of my talking. It's all good. It's good. good. I do have one one-off question. So, because we didn't talk about this in terms of of the kind of the questions we asked. So you you guys do ask about like um dental things, right? Like dental implants, things like that. Tell us why you ask about that and why it's important to disclose all those.
Speaker: um So in a lot of procedures, we would need to place a breathing tube. And in order to do that, we have some tools that we use that will be placed in your mouth. So we want to be really cognizant of your teeth and we do everything we can do to stay away from them. But, you know, sometimes if you have loose or wiggly ones and they they get in the way of um putting that in, we just kind of want to have a conversation with you ahead of time of what you can expect. and It also helps us assess if anything happened during the surgery that we we need to discuss afterwards.
Speaker: Awesome. I was going to ask, I have so many questions. I even have questions I want to ask you guys offline that I've been thinking about. Oh, absolutely. Yeah, we love it. I think going to definitely have to do a part two because I'm like, wait a second.
Speaker: I just want a whole clinician an episode because I have all of these things I want to ask about. I'm thinking of patients last night, like, should I have done blah, blah, blah? Okay. But, Noelle, you said yes you like you're OB, um which, wow.
Speaker: um ah that I'll tell you that I've had... a handful of surgeries in my life and I have had three C-sections. I have never been more terrified of an epidural in my life. yeah um And it was just largely, just truly just the procedure. It's like my spine, all these things that independent of being in healthcare care and that I couldn't not think about. But you're not in the traditional operating arena that we think about anesthesia is putting us to sleep. You guys function in many spaces outside of the ah OR.
Speaker: Talk a little bit about those spaces. Where does your practice happen outside of the operating room? And I like to refer to them as field trips, right? I'm going on a field trip. So we're like the, one of the ah specialties that really has our fingers on the pulse in every department of the hospital. So we often like to visit the cath lab. We'll go up to labor and delivery deck. um We go to interventional radiology.
Speaker: We work in the endoscopy suite, MRI and imaging. There's a lot of times we anesthetize patients there. We can do some pain management type things, procedural clinics. And then um we partner a lot with pre-anesthesia testing too, which is a site that we often staff. So I think um when people think of anesthesia, like you said, Alicia, it's like really right in the main OR, but we we have all these other exciting field trips that we get to take throughout the day to help care for patients throughout the hospital.
Speaker: Yeah, and even in outpatient settings too. i mean, we were just, April, were talking about teeth. Just made me think of... anesthesia in the outpatient. Yeah. Outside of the hospital, I think a lot of anesthesia providers, um not necessarily um with our organization, but dental clinics, especially pediatric dental clinics, um they provide anesthesia offsite in in their offices, plastic surgery offices we do a lot in. So yeah, a lot of opportunity for to share our love. The ghost of medicine. That's the
Speaker: You're my little mouse. Just kidding. I'm that scared of you, but you guys do intimidate me. but No, we're so friendly. And you wouldn't remember talking to us afterwards anyway. so That's absolutely right. But you guys, apparently I'm chatting. April is too. We've learned, we've exchanged stories that we just probably say raunchiest or most inappropriate things um under him. least when we're waking up. So that's okay. It's like Vegas. and its yeah like what nothing happened yeah yeah but We know nothing. Noelle and I have folks who have been doing anesthesia for a while. um i always challenge folks who are worried about those things. Like i I am certain you cannot say something that I have not heard already. Oh, I bet. And I bet you guys hear
Speaker: even more like i always said i want to do this medical like just a um not a nightstand book or you know just a coffee table book but just of just stories or one-liners or even just quick two-liners of what we what's been said to us what we've seen just something there's just i have some of the funniest funniest stories but there would only be humor to people in medicine i think yeah sorry i'm sure that's funny All right, guys. Well, one last question, and you've already touched on this a little bit, but you know as you're moving around all areas of the hospital, um you know there's obviously a lot of opportunity for us as hospitalists to collaborate with you um you know on the inpatient units as well as some of our pre-admission testing clinics that we have. But any other like what other opportunities for collaboration do you think are important for people to understand or are important for you to do your job on a daily basis?
Speaker: And how can we help? Yeah. Yeah, well I think one of those things is just ask the question, right? Like as clinicians, sometimes we, um myself included, we sometimes are, gosh, gosh do i do I want to call the hospital with service about this patient? I just have this question in the PACU and, you know, should we, yeah am I bothering them? They're they're so busy. um But I think coming back to, you know, the thing that centers all of us is we put the patient in the middle. If that were back back to to Noel, like if that were my patient, if that were my if that were my family member, what would I want my clinicians to do? And we never want anybody to not pick up the phone and call us um if they've got a question. There is no question that we do not want to answer to to promote better patient care. no matter big, small, or otherwise. And I think that would be what I would say is just call us. If you're wondering or if you think that asking us a question might help, we want to know. we want to We want to be able to provide that great care for you as clinicians and for our patients.
Speaker: Yeah. Awesome. Anything on your end, Noelle? No, like Sarah said, just call us. I think we're all pretty approachable people. It's all that anesthesia gas that we inhale all day, but pretty down to earth.
Speaker: There's not a crazy question, i promise you. So yeah, give us a call, please. I would tell you, reciprocally, my, not even, not advice, but my feedback to you coming from our specialty would be, I would, I'd love to hear you guys say that more um in our practice. You guys were such a scarce resource for so, so long. um And now that you are available, i think I still have a scarcity mindset um with it where I'm like, I don't want to bother. Or is this the case, you know, the right case to bring forward? Is this the right plan? Like, can I manage? And we we sometimes we we straddle that line a little bit, but it is helpful
Speaker: for me to hear you guys say that and it's something that we can echo on these airways for everyone to hear that they want they want us guys they want us to bother them now so we can do that yes please that's what i heard noelle wants to get called all hours day that's what i heard yes call me i always have my heart but you probably should eight days there's 30 in this month i have two more i got 15 minute three weeks from now that's all good yeah That's right.
Speaker: All right. And close, cause I, and I really, swear guys, we are going to have to do part two because I have so many questions, but in closing, i just wanted to ask you guys this question and know how you started with, a you know, taking care of your family, but when our listeners, anybody that's listening to this independent of what their, their roles are, their specific jobs, when they find themselves or someone they love needing you, you, your services, what you do, what's the one thing that you hope that they remember from this conversation today?
Speaker: I hope they remember that they're they're never alone. as Sarah alluded earlier, we we are always with you and we wanna answer questions, not just for the patient, but for the family members. I i know I always ask um in my interview, you know mom do you have any questions, dad, sister, whoever their support person is? um So just remember that they're they're never alone and and anesthesia is super, super safe, but it's okay to be nervous.
Speaker: that All of those things. like And we've got your back, right? We're there with you the whole time. we we are We're all on the same team, and we're all going to get through safely, comfortably, and we'll we'll see you in the wake-up room when we're all done. That's right. Round trip, Anistia. See you in wake-up room. See, I think you guys to have a podcast on your future, and your closing line is, see you in the wake-up room. Right? April, we could do a collab. We could grow off. Listen, we're doing business. Hey guys, think of that thank you. and i know. Just took some delusion and and bringing some bigger brains into the room. Yeah. i love In a mouth.
Speaker: It was awesome having you guys. I can't even begin to tell you how much you just woke me up and how much you're going to be annoyed with the emails I start sending you after this podcast. Thank you. Thank you both for coming on and yeah sharing your expertise. And I hope you guys are open to two coming back and when You start your podcast, you have us.
Speaker: Absolutely. We can help you with your first episode. We'll help you launch. But yeah, it's been awesome having you guys and also getting to work with you collaboratively in our roles has been really fun. And like I said earlier, watching you guys grow has been awesome. So um to all of our listeners, thank you for listening. As always, if you have any feedback, you have questions, you have suggestions for us, you can find us on Instagram at On Call with April and Alicia. You can also email that email address that Alicia really wants you to use. It's called nooneemailsusatsoundphysicians.com. And we'll see you next time. But also LinkedIn, anywhere where you guys get your socials.
Speaker: um You can find us on any outlet where you can listen to the podcast. We'd love to have you guys follow along with us. If you guys have questions about anesthesia, um Noel and Sarah's information will be in our show notes. You can reach out to them and their respective email addresses and they can talk to you about career opportunities or whatever it is they're looking for during their growth. So yeah.
Speaker: It was awesome having you guys on here. Yes. Thank you guys. Thank you much. Yeah. Thank you. And until next time, you guys stay well and we'll stay on call. Bye everyone. And we'll see you in the anesthesia room. What'd you guys say? We'll see you in the wake up room. See you in the wake up room. Bye everybody. Bye guys.
