What really happens in an operating room?

In this episode, I go behind the paywall with a Chief Anesthesiologist, Dr. Sudha Shah, who spent over 40 years running quarterback in operating rooms. We discuss why anesthesiologist are often the leader of what happens in the operating room but most patients don't really know or remember who their anesthesiologist  was.

Transcript

SPEAKER_01 0:00

Welcome back to Behind the Paywall, a podcast where I dive into different workplaces and explore them. Today we're sitting down with an anesthesiologist, a doctor whose job most people only think about for a few seconds before surgery, but who is actually responsible for one of the most critical parts of modern medicine: keeping patients alive, stable, and unaware during procedures where control is everything. We're going to break down what really happens behind that operating room door, how decisions are made in real time when a small little mistake can have serious consequences. What it feels like to be responsible for someone's life while they're completely unconscious, and how you stay calm in an environment where things can change in seconds. Today I'm here with Sudasha. So tell me a little bit about yourself and what you did.

SPEAKER_00 0:51

Okay, I'm Sudasha, anesthesiologist. Uh I'm retired now, but uh I have practiced for 45 years, and I was chief of anesthesia during my practice for a few years. Uh and then mostly I have worked in the community hospital as an anesthesiologist and also as an OB anesthesiologist and also managing some of the chronic pain management.

SPEAKER_01 1:26

So then how how would you get your patients to trust you? Because I've done anesthesia all the time anesthesia and you know I never met my doctor, you know, I never had a conversation with her. So how did how do you how does a patient decide to trust you with their life?

SPEAKER_00 1:41

I think it is very rare that you don't see your anesthesiologist before your procedure. Usually the anesthesiologist are um pretty um involved with the patient's care because uh they are in in fact they are the managing before, during and after the surgery, all the critical management of the surrounding the patient of the patient. So usually we do even week before, one week before we go through the patient's chart and then see if there is anything unusual we need to know, and then on the day of surgery, we all see patients. And I know it is very short time we get it because just it's uh so many patients going through the operation and surgery, and everyone is busy, but in those short times, beforehand, we know already the patient is healthy or not, and how much time we need to spend with the patient, and we do develop some kind of relationship with the patient, telling them what's going to happen to them, what to expect from anesthesia, and if they have any concern about anesthesia, ask us questions and we can answer them. So it's very rare that anesthesiologists don't see patients or don't talk to patients before procedure. I think majority of the time we all see our patients and try to develop that trust with them, with our knowledge, showing that we know about their medical history, we know them, what to, what's their fear, what are the risks of anesthesia, explain to them what uh what can go wrong and uh ask, I mean, just answer any question patients have.

SPEAKER_01 3:53

So that's how that's how your trust is developed with the patient. It's yes, you know, showing that you have an extensive record of their medical history, and then also explaining, you know, what what is supposed to happen during the surgery and then what they can expect after. After correct.

SPEAKER_00 4:11

Correct. And if they have any concern during so about anesthesia, they can ask us about that question, and then we can tell them what to expect. So what what misconceptions would you say people commonly have with commonly misconception uh people have that anesthesiologists are just like a technician, just give some medicine to put patients to sleep and then sit back. But that's not true. The anesthesiologists are fully MD, go to the full medical school, and then they go for the anesthesia training, and uh they are just MD just like any other surgeon or any other speciality in the medicine. Um they are also they're not only they just put you to sleep, that's the most patient thing, but they also give take care of your pain, chronic pain, without surgery you have if you have the pain. There are so many types of anesthesia, not just going to sleep, but local anesthesia, regional anesthesia, and also they are the ones who takes care in emergency or critical in the emergency room, especially the managing the airway. You know, if you are unconscious and they need some resuscitation without anesthesiologist, it's not really completely they can do. So they they play a very important role in the patient management, uh, critical emergency in the operation before surgery, after surgery. And that is the misconception most patients don't realize how how much important they are, and sometimes they think uh they are not empty, and sometimes they are very um kind of speculative about anesthesia, whether they will be really sleep or not, whether they will wake up or not. So these are the misconception most patients have about anesthesia.

SPEAKER_01 6:38

And then the you're you're there the entire time during the surgery, regardless if it's a 30-minute surgery or a 12-hour surgery.

SPEAKER_00 6:46

We are constantly there. Actually, you can say that we are the pilot of the whole that plane going on during the surgery. Whole operation. Because whole operations. Surgeons are just focusing their surgery technique and they are doing surgery, but anesthesiologists are the ones who are making all the critical decisions about the patient whether and not have the monitoring the patient's vitamins also taking away their pain, make sure that they don't feel any pain, make especially during the surgery. We are the ones who makes all the critical judgment and decision how to stabilize that patient's condition and just go pass through during the whole surgery safely without any complication.

SPEAKER_01 7:45

So then a call, I I feel like a common reaction from people would be like, oh, I can fight off the drug basically, you know, maybe I can stay awake because that's how I felt, and you know, I've talked to people and they've they've almost said the same thing. So have you ever seen anybody almost like fight off the drug or you know, wake up during surgery?

SPEAKER_00 8:05

This is the whole physiology and pharmacology, dianesthesiologist know that it's not one fixed drug or not the one fixed dose which works for all the patients. So we know about the patient's physiology, we know how much how much he he or she will need medicine. Accordingly, we just monitor and give the medicine or anesthesia, which is like uh some inheritance anesthesia. Uh so it's there is no way that patient will not be anesthetized because we know yeah, no, no. And uh it's uh just like I said, it's not the fixed dose for every patient. So that's why it's so important having the knowledge of the pharmacology and physiology, and about the patient's condition, health condition, how his health, like you know, uh obese patients need more anesthesia, sick patient needs this anesthesia, so that's that's the whole critical role of anesthesiologist. There is not a fixed thing, fixed dose or anything, and so all patients go to sleep and they wake up too. It's very rare that there are complications nowadays.

SPEAKER_01 9:29

So then what would you say like is an irrational decision that would be in that was in your field of work that you would see you know every day and you'd be like, this doesn't make sense, but you know, it still happens every day.

SPEAKER_00 9:47

I think um only thing I can see that maybe like the patients, so many patients don't realize what important role anesthesiologists have during the surgery, after surgery, or in their perioperative care. Uh and it happens every day. They they really don't realize how important uh in their you know procedure uh the anesthesiologist has or anesthesiologist makes all this critical decision about their life in the operating room.

SPEAKER_01 10:30

So you think it's almost as important that the patient would be to spend as much time with you as they would their actual surgeon?

SPEAKER_00 10:40

No, because it's not possible practically, but every patient should spend some time, even 10 minutes. I think within 10 minutes we can explain to them and then they can see that how much we know about medicine, how much we know about their health condition, and we can explain what are the risks, and maybe they then they can understand that yeah it is important um to have an anesthesiologist, um, you know, good anesthesiologist for that procedure.

SPEAKER_01 11:17

So do you think it's essential that a patient should do this or should they just automatically be able to just trust their anesthesia?

SPEAKER_00 11:25

I think I think all patients should talk to their anesthesiologist, should ask them questions, what's their concern or what they are going to do? What do I think?

SPEAKER_01 11:38

What should they be scared of? Yeah. And then let's say the patient didn't feel like their doctor was qualified enough. Could you request another doctor? Or is it kind of just who's given to you?

SPEAKER_00 11:50

No, no. You can always if you don't like your uh doctor, your anesthesiologist, you can request uh another anesthesiologist. After talking to anesthesiologist, you feel like uh you you don't trust him or her, you can request another anesthesiologist.

SPEAKER_01 12:08

Okay, well that was great. Thank you so much for your time.

SPEAKER_00 12:10

Okay, you're welcome.