Anesthesiology: Laura

Show Notes

In this episode of No Referral Required, Mandy, Courtney, and Lara sit down with anesthesiologist Dr. Lara for an eye-opening conversation about one of medicine’s most misunderstood specialties. From the moments before a patient falls asleep to the critical decisions that happen throughout surgery, Dr. Lara pulls back the curtain on what anesthesiologists actually do—and why their role extends far beyond simply “putting people to sleep.” She shares her unexpected journey into anesthesiology, explains her fellowship in obstetric anesthesia, and offers fascinating insights into labor and delivery, surgical safety, pain management, and the teamwork required to care for patients during life’s most vulnerable moments.

The discussion also explores the emotional side of medicine, touching on trust, patient fears, trauma-informed care, misinformation on social media, and the growing role of artificial intelligence in improving patient outcomes. Dr. Lara reflects on the privilege of caring for people during some of the happiest and hardest moments of their lives, while the hosts keep the conversation engaging with personal stories, thoughtful questions, and a fun speed round that reveals the human side of life in the operating room. Whether you’re preparing for surgery, curious about anesthesia, or simply love hearing honest conversations with healthcare professionals, this episode offers reassurance, education, and plenty of memorable moments.

Transcript

Lara [00:00:08] As a reminder, this podcast covers sensitive and sometimes difficult medical topics. Listener discretion is advised.

Courtney [00:00:25] Hey, everybody, and welcome to episode three of No Referral Required. Hey, guys. We are so glad that you’re here. We’re all here. Everybody’s back. It’s Mandy. It’s Lara. Hi. And I’m Courtney. And we are just so glad that you have chosen to join us today. And we have a wonderful guest with us today.

Lara [00:00:42] So excited. We have Lara, a friend of ours who is an anesthesiologist. Yay! Drug pusher. Yay! We’re so excited she’s here for numerous reasons. But interesting to note, 75% to 80% of the American population at some point is going to have general anesthesia. And I think it’s a topic that a lot of people, if they’re not in the medical field, don’t know a lot about. It’s kind of mysterious. A lot of job security there. So we thought we would be excited to learn a little bit more about what life is like in your field. So maybe we could start, tell us a little bit about your background and why you chose anesthesia.

Lara [00:01:24] Ooh, my background. So I think going into medical school, I would say anesthesia is one of the fields that gets the least attention. So you barely have five days of a rotation when you’re trying to decide what you want to do for the rest of your life. And I had my five days, and I said, nope. Promising start. Not doing that. And I think it’s because it’s so, it has so many high level skills that you can’t let someone, you know, walk through the door and start doing all of the exciting stuff on day one. Oh yeah, sure, so you’re observing.

Mandy [00:02:10] Makes sense. So not hands on for a long time. Right.

Lara [00:02:14] And a lot of the time, the residents that they pair you with are very new themselves. And so, it’s even more stressful to have a medical student with you. And so, oftentimes, the residents would be like, hey, do you wanna have an early day? And you’d go, no. Code four, get out of my space. So I was like, man, this is pretty boring. I think I’m, I’m not going to do anesthesia. And so the way my medical school worked is that we were paired with a mentor to kind of go through the end of medical school with you, applications where you’re going to, you know, do sub eyes, things like that, just to be like a mentor with you. And you give them kind of the gist of like what you want to go into. And so I was thinking, Oh, I really like critical care, I liked pediatrics, I liked obstetrics so I gave them all of those and they gave me the chief of Peds Critical Care who was an anesthesiologist by training and my day with her was Tuesdays which was her OR day. Yep, and so we ended up in the OR and she changed the whole trajectory of my life. Wow, because you got to really get in there and kind of see what it’s really like. She did peds, so like we were just holding these little kids and we’re singing them songs and telling them stories and it was the best. She was amazing.

Lara [00:03:48] Now you are a specialist in anesthesia. So they say. You are special. I’ve seen it with my own eyes. I think that’s something a lot of people don’t know, that there are specialties within anesthesia and that there are concentrations of specific kind of skills and populations. So it’s not just, you can’t just slot in one anesthesiologist, you know, for every single thing. Could you tell us a little bit more about what specialties exist and about your choice?

Lara [00:04:21] So we’re all going to do a four year residency. Everybody does a little bit of all of the specialties. And then if you want to, you can practice as a general anesthesiologist. And depending on where you practice, you may do more or less of all of those things. Or you can choose to do a fellowship. I did my fellowship in obstetric anesthesia. You can do pediatric anesthesia. You can do critical care where you’re more in the intensive care units. You can do pain medicine. You can do palliative care. you can do regional anesthesia.

Mandy [00:05:01] So depending on- Which is blocks, not part of the country.

Courtney [00:05:04] This is southern anesthesia. What does southern anesthesia look like? Northern, west coast. Pacific, northwest.

Mandy [00:05:15] Block an arm. Block the leg. That region. There we go.

Lara [00:05:22] Yes, yes, good clarification.

Mandy [00:05:27] But West Coast sounds nice. I know. West Coast anesthesia?

Lara [00:05:30] But many of us do many different things. And so I do a lot of obstetric anesthesia because I’m in academics and that is what I was recruited into my position to do. So a lot of women’s health anesthesia.

Lara [00:05:49] And tell us a little bit about what that looks like. What does an obstetric anesthesiologist do on a day-to-day basis? You come into work and What is on your list for the day?

Lara [00:06:00] So if I’m on labor and delivery, where I’m going to do at my current place of work, only obstetric anesthesia that day, we’re going to take sign out of the board. So the team that was on during the night is going to tell us about all of the patients that are on the board. And what many people might think is that that ends with who has an epidural and who doesn’t have an epidural. Because what a lot of people think is if they don’t have an epidural that I’m not involved in their care. I don’t even know that they’re on the floor. But no. You’re in the wings. No. If you had been trained by me, you would hear me say, all of the patients on this floor are our patients. Because I think a lot of people don’t realize that at the end of the day, if something gets complicated in a patient’s care, or if something starts to take a negative turn, maybe there’s an allergic reaction, or maybe someone with preeclampsia turns into eclampsia and they have a seizure and they’re having trouble breathing. All of those events come down the line to anesthesia. And so if I’m meeting that patient in extremis for the first time, it’s not a good look. And I might not have all of the information that I need to care for her in the best way possible. So we see everybody that comes onto our floor, even patients that have already delivered, which I think that can be really confusing to a patient, especially if someone is celebrating maybe a birth center delivery where they absolutely did not need our services. We celebrate that too, like that is hard stuff right there. But when you come into the hospital, there’s usually a reason for that. And we just want to make sure that we have all of the data to keep you safe. If anything bad were to happen while you were in house. Yeah.

Courtney [00:08:07] So do you go introduce yourself to those patients? Like as the, you know, doing rounds, letting them know you’re there.

Lara [00:08:13] Yep. We take a full intake and we’ll talk about simple things like, if you’ve ever had anesthesia before? Has anyone in your family ever had trouble with anesthesia before? Do you have any allergies? Do you take any medicines for any issues when you’re not pregnant? Just very simple medical background questions.

Courtney [00:08:33] Well, the people have that you’re like getting the handoff of the board, have they have already asked those patients that same question and now you’re going to come in and ask them again? Or how does that work?

Lara [00:08:43] Yeah, that’s a good question. We won’t go back and see them again. We won’t keep bothering them every day. Now the eighth time. What’s your allergies?

Courtney [00:08:52] Patients love that. That’s what I was going to say. That doesn’t sound fun, but okay. Wake them up at three in the morning. All bright-eyed and bushy-tailed and you’re like, I just had a baby. Yes, I’ve done that.

Lara [00:09:06] And you said you were a Scorpio? No, not right. How do you feel about that? No, we won’t do that. We won’t do that. We have a way of transferring information safely, only information that we really need to take care of somebody. And so we keep it in our medical record system. And if there’s anything pertinent, if we found out that someone had had congenital heart disease and had had surgery on their heart when they were younger and made it through their entire delivery and nobody knew. You would be surprised how many times my little residents get in here and find out information.

Lara [00:09:49] I actually wouldn’t be surprised. I’ve been surprised before, it’s not a great feeling.

Courtney [00:09:55] So that’s the day that you’re in the hospitals? Is there ever a time where you’re not in the hospital? Like where you’re in a clinic setting? Or where else do you guys show up?

Lara [00:10:07] , some of us, myself included, rotate through ambulatory surgery centers. Okay.

Courtney [00:10:15] So that’s like the same day patients kind of thing.

Lara [00:10:17] Yeah, exactly. So if you’re having a colonoscopy or if you’re having a cataract or if you’re having minor plastics procedures, lots of stuff is same day surgery. Oh gosh, so much. Absolutely. So you could see me in an outpatient setting. That being said, it’s not going to be a clinic. There will be operating rooms and procedural suites.

Courtney [00:10:45] Yes. Okay. Do you ever go through the ICU and is that, do you ever follow a patient to ICU or is it a handoff situation?

Lara [00:10:53] I may go up there if we’re having a delivery of a patient in an ICU setting, which is, It’s pretty rare but becoming more common and we can talk about that a little bit more. So I may go up there or if I’m having a day where I’m practicing general anesthesia in an operating room, I may pick up a patient. or drop off a patient or if I’m on call and the call team is busy and there’s an airway that needs to be secured I may respond to a request for an airway as well in an ICU.

Mandy [00:11:33] Okay probably most people don’t know Courtney that a lot of the code teams when there’s a code blue have an anesthesiologist in that team. Okay So you’re always… Because they are the best and most skilled usually at your airway and difficult IV access and things like that.

Courtney [00:11:49] Okay. Yes. No, I didn’t know any of these things. You were the number one person that I wanted to see as soon as I was, well, when I was, in my experience, I was, my first surgery that I ever knew, I had C-sections, but No offense, I didn’t count those really as true, I know they are true surgeries, but I was never being put under, so this was my first time to like, I did, look at that, that didn’t work, and then I had to get more, and I had propofol, and I was very terrified of that, because it was, recently after Michael Jackson passed away, and I was, , I was like, isn’t that what Michael Jackson had? And this hand on my shoulder was like, that’s not gonna happen to you. And I was like, okay. Anyway, it’s a whole story, I could tell you, but I’m sure you’ve heard it a thousand times. Well, okay, right. Right.

Lara [00:12:43] I don’t know that he had a code card. I know, yes. Definitely not an anesthesia provider.

Courtney [00:12:49] Right. but they parade all the doctors in front of you. Everybody who’s going to be your doctor just gets introduced to you, introduced to you, and that’s very overwhelming. For me it was. They were like, do you normally have high blood pressure? I was like, I do not, but this is freaking me out. So my number one question was to find the anesthesiologist, and it was kind of a crazy story, because I’m a redhead. Don’t you know this? Yeah, true, but is that a thing? Is that real?

Lara [00:13:22] I think if you talk to enough anesthesiologists, you may get some people to say yes.

Courtney [00:13:28] I don’t think that the science has really…

Lara [00:13:36] has really borne out anything that we can, you know, stake a claim on. But I do know a lot of people that come in and tell me that they’ve been told by other anesthesia providers that it was because they had.

Courtney [00:13:52] I had an anesthesia I was just walking to while I was in labor and he was trying, he was gonna do the epidural and he literally said, oh crap, another redhead. And I was like, no. And the nurse was like, don’t freak out, don’t freak out, he’s really mean, but he’s the best anesthesiologist, so just don’t argue, just don’t argue. I was like, great. But yeah, that was a different experience. But. I’m sorry about that. That’s okay. That’s not what we’re talking about. Apologize for your entire field. No, you’re not. No, you’re not. That’s not what we’re talking about. So you’re in the hospital most days, or in a surgery center. Do you have an office? Do you do paperwork and all that lovely stuff that I keep hearing them talk about?

Lara [00:14:35] I do. I am also an administrative leader within our team, and so I do have an office. And I’m in there occasionally. It is very close to the workroom. So even when I’m working, I can pop into my office and answer some emails or meet with somebody that needs to be met with.

Lara [00:15:00] Okay, great. Awesome. What is the biggest change you’ve seen in your specialty over the past 10 years, would you say? Or biggest changes? I know there’s been a lot that has happened in medicine.

Lara [00:15:13] Yes, I think probably just the overarching distrust of medicine, I think has really boiled down in anesthesia. Really? What do people say? Yeah. Well, because we were associated with the pandemic in such a big way. Really? Right? Because people that were in the ICUs people who were having trouble breathing, who ended up needing help with that breathing. Many of the people that were still interfacing and performing their jobs in a very regular way were ICU doctors, nurses, anesthesiologists in the operating room. And so I think that we’re a face that people very closely tied to that time and you know many people still to this day have very different feelings about that period of our history.

Courtney [00:16:22] So you feel like they don’t trust you? You feel like they don’t maybe are more hesitant to?

Lara [00:16:26] Well I think it’s additive because so much of like what you said even my own mother when I told her I was going to be an anesthesiologist she’s like so you just put them to sleep and you leave? And I’m like, no. Go home, have a nap. No, no. But it’s a very poorly understood field.

Courtney [00:16:47] So what do you actually, so let’s talk about what your mom just said. What do you do? I’m going in for surgery, you meet with me beforehand, I meet you, you tell me to count backwards, and then I’m.

Lara [00:16:58] Which we don’t really do. Okay, okay.

Courtney [00:17:02] Myth number two.

Lara [00:17:05] In Grey’s Anatomy maybe.

Courtney [00:17:09] But so you get a patient to be comfortable and asleep as much as they’re supposed to be and then you.

Lara [00:17:16] If we’re doing general anesthesia, yes.

Courtney [00:17:19] And then you fill in the blank.

Lara [00:17:21] And then we are inducing general anesthesia. So when you’re going to sleep, we call that an induction of general anesthesia. And that’s when we drift you off to sleep. And then after you drift off to sleep, we have to make sure that we have an airway because you’re not capable of holding one on your own. And so we place a device that will help us to do that. And then sometimes, depending on what the surgeon preference will be or what the surgery requires, we can let people breathe on their own with that airway in place, or we might have to breathe for them and we use a machine called a ventilator to do that. Okay. Breathing devices go in your throat, which is a really stimulating area. And so people need to be asleep when they have those devices. So we maintain anesthesia with either IV meds or inhalational meds that go through the breathing device or a combination of the two of those. And we can do that for however long the surgery takes. And then we start something called emergence where we pull everything back slowly, make sure that you’re breathing on your own and that your vital signs look good and that you’re capable of protecting that airway when we take out whatever device we have in and you wake up.

Courtney [00:18:48] So you’re constantly monitoring a patient?

Lara [00:18:50] Yes.

Courtney [00:18:50] Are you watching brainwaves? How do you monitor somebody’s…

Lara [00:18:54] So there’s core vital signs that we monitor for every surgery. Things like blood pressure, heart rate, how your oxygen saturation is. But there is a monitor that sometimes you may see on if you if you’ve ever had glue on my forehead And it’s very salty I And we can watch brainwaves to keep it very simple. We can watch brainwaves and you can think of it when you’re sleeping, you have different patterns of brainwaves. And so when you’re under anesthesia, you can also have different patterns.

Lara [00:19:36] That rolls into a question we were gonna ask about consciousness under anesthesia, which I think scares a lot of people. Is that a real thing? Does it happen often? You mean coming awake while you’re under anesthesia? Yeah, but still being paralyzed.

Mandy [00:19:54] I didn’t even, sorry. I love that, that’s cool. Now you have a nightmare. I used to hear it a lot.

Lara [00:20:00] It’s very rare. It’s very rare, and we have lots of safety mechanisms to make sure that somebody is truly asleep when we want them to be asleep, right? I think some of the stories that have been passed down and talked about, are the fault of our field for not explaining things properly. I’ll give you a great example that I have to talk about almost every time I’m at a surgery center. People say, oh, am I going to have to watch my colonoscopy this time? I had to watch it last time.

Courtney [00:20:36] I’m like, what?

Lara [00:20:37] I’m like, okay, no. My neck doesn’t bend that far.

Courtney [00:20:42] How could you even?

Lara [00:20:46] Years ago, we did not explain to people that there was a choice, right? You could have your colonoscopy under midazolam and fentanyl, or you could have your colonoscopy under propofol. If you have it under propofol, that’s an induction agent, so we can induce general anesthesia with propofol, okay? It’s a very different experience, a much deeper plane of anesthesia can be obtained with that. Those two other medications are great medications and they have their uses and some people will sleep through a whole colonoscopy with those two medications, but some people will not. And it used to be that there were certain insurance plans that would only cover one way. And so we didn’t explain to people, we didn’t explain to people, you had this, so you could expect to feel this, right? And so I have to clarify that to people in their life. Like, oh, well I wish I would’ve known that. I’ve been scared every colonoscopy since. And so I think a lot of education goes so far.

Courtney [00:21:57] Yeah. Do surgeons ever ask you to keep, I have two questions to this. Do surgeons, that shall not be named, I’m just kidding.

Lara [00:22:07] We are perfectly well-behaving. I know.

Courtney [00:22:11] Is there ever a time when they want a patient to be awake-ish, like to sit up, to do something, and you have to bring them back up, and then they do whatever it is that the surgeon wants them to do. I’m thinking plastic surgery or that kind of situation, like make sure things look right when they’re sitting up and not just laying down. Is that true? Does that really happen?

Lara [00:22:40] Oh, for sure. For the plastics part, I’ll answer that first. We are not going to wake them up for it. If you want to talk about breast surgery, gravity matters, right? So you’re going to want to know that it looks great laying down, sitting up, sitting sideways, right? And so we will change the position of the bed during many of those cases.

Courtney [00:23:03] But you don’t take them out of any kind? No. Okay, but are there other times when you do because it’s helpful to the surgeon?

Lara [00:23:10] Absolutely. So different neuro or brain surgeries sometimes are done with the patient completely awake. Yes, those are the things we have nightmares about. But it’s actually, it’s possible to have one of those surgeries and have the patient be totally comfortable, relaxed. We get the information that we need for it to be a successful surgery. And everybody looks back and says, man, that was a success.

Courtney [00:23:40] Do you, do you have a, my second part of that question, do you really have a medicine that wipes people’s memories?

Lara [00:23:45] We, we do have medications that interfere with the formation of memories.

Courtney [00:23:50] Ah, okay.

Lara [00:23:51] So you get it on the front end and then if anything is, well, we have some that are anterograde and then some that are retrograde. Okay. So it depends. So it’s different agents for, for everything. Yeah. It’s never our desire to say, Oh, we just need to erase everything that nobody sits around. Right. Right. Right. Right. but there are different experiences that I’ve had in medicine where I’m so grateful that I don’t remember.

Courtney [00:24:22] The last thing I remember is you telling me to get to that bed, but I don’t remember doing that. I assume I did, and I assume I did it myself, because I know that’s one of the big hurdles to moving a patient. That’s hard to do. So I remember them being like, put your head on these purple things. And I was like, I remember being told, do not remember doing that. but still had the surgery just the same, so.

Lara [00:24:46] And many people, if we give that medication, will be like, well, I don’t know if you gave me that medicine, because I don’t remember this part last time. And I want to say you’re not going to remember it this time either, but no one ever believes you when you say that. So it’s just like, oh, we’re going to take great care of you.

Courtney [00:25:03] That’s funny. Moving on.

Mandy [00:25:05] That’s funny. What scares you the most in your field?

UNKNOWN [00:25:12] Oh man.

Lara [00:25:13] It’s a therapy session now, it starts now. There are so many scary things in agency. A lot of times you guys are at the really critical junctures. You guys are the ones who are there. Yes.

Lara [00:25:28] I think that it’s not having enough hands. Because we are in this time where resources are so short. Are you usually alone? I’m not.

Courtney [00:25:43] Okay, so you have who’s with you when you’re in a surgery.

Lara [00:25:47] That’s another great question. So I will always have at least one in-room provider. Okay. And so that can be an SRNA, which is a student studying to be a CRNA, which is a certified registered nurse anesthetist. Or I could have a CRNA, or I could have a resident, which is a physician that is doing their residency in anesthesia. Or I could have a fellow as well in that room.

Courtney [00:26:17] Okay, but you would never by yourself?

Lara [00:26:19] I will never, well, Can’t say never, because where I used to work, we did set our own cases. But with shortages being what they are, and you can just have one anesthesiologist run more rooms and accomplish more medicine in the model where there’s a team approach.

Courtney [00:26:40] But the anesthetist could be alone. Okay. Okay. Yes. Is that like a handoff situation? Like the anesthesiologist gets it going and gets everything to the place where everybody’s comfortable. The surgeons feel good. Everybody’s good. And then the anesthetist kind of. takes over and monitors?

Lara [00:26:57] So we are there for induction and emergence, so remember the beginning and the end, and then anything where there could be higher stakes, so we’re moving positions like you talked about, or I’ll give you an example in cardiac surgery, if we’re going on and off pump for cardiopulmonary bypass, or if anything is just not going normal or smooth, like the blood pressure’s too low or too high, or the heart rate’s too low or too high, or our oxygenation levels aren’t where they should be, then the anesthesiologist will come back into the room.

Lara [00:27:40] . Okay. I’ve definitely been in situations where I’ve asked the anesthesiologist to come back saying we’re having bleeding or something’s concerning from my end. Anticipating we’re gonna need a little more attention. Okay, and we might need blood or we don’t need some help pager situation Is that a call over the intercom?

Lara [00:27:57] What do we do? Multiple ways of finding out that we need to come back. Open the door. Come on in Come back, come back. I have people out in the hallways. Let’s go get some help. And that’s the great thing about most settings that are surgical in nature is that the teams that are built, most people know everybody. There’s very rarely somebody that doesn’t have my phone number and my pager number and knows how to call overhead. We’re a really tightly knit team. And if it’s my in-room provider calling me back, or the circulating nurse, or the surgeons, or the residents, it would be all the same to me, because we’re all looking for the same outcome. And want to take great care of the patient. So that’s what scares you the most is being For example, I had a shift recently where I It was just so busy. So on labor and delivery, I have a team, myself being the only attending that’s on if it’s a call shift. And then I had, let’s see, I had two residents, a CRNA and an SRNA with me. And we had three very sick patients that were in the operating room. And then we also had sick patients that were in labor and delivery rooms. And two of them were flirting with needing their care escalated. And, , I did not have the ability to be in five places at once. And while I knew exactly what I needed to do in all of those locations, we called for backup and those backup teams were also saturated. And so everything ended up going well and you just keep moving along. Just like Elsa says, what’s the next right thing? But there are more and more times in healthcare where we are being asked to do Very, very critical care medicine with less people resources and less like physical resources too, right? Especially in anesthesia and surgery, we do so many things with plastics, this oil situation. the number of emails I get every day saying like, hey, we can’t make the plastic for syringes or because we don’t have, you know, yes, like supply chain, right?

Courtney [00:30:49] Yeah. Okay.

Lara [00:30:51] So I think that scares me because it’s not, it’s not getting any better. Okay.

Mandy [00:30:56] Yeah. Okay. On that note, if you had to give patients in general, all of America and the world, one piece of advice about having anesthesia or having surgery, if you could say, this is my advice to you, what would you tell them?

Lara [00:31:15] Oh, probably what I told myself. Before anesthesia? Yeah, before, before I had to have surgery. So I think what makes having anesthesia hard is that you have to give up complete control. You have to give it up in its entirety, but you also have to do it with somebody that you have never met in your life. Most of your patients have met you guys, right? And you have a nice little relationship and you know, they’ve never seen me and I have maybe five, 10 minutes maybe for them to decide that they can put their actual lives in my hands, right? And so it’s a challenge that I really like, I like trying to make a really meaningful bond with people quickly. I think that’s why I like obstetrics so much. My patients are usually awake and it’s either the best day of their lives or really like one of the worst. I love that intense relationship that you form with someone. I think it’s beautiful in like many, many ways. But I would say that you need to trust and really work on giving up a little bit of control and trusting that the person that is going to take care of you has your best interests at heart. I know that’s heavy because I was not very good at it myself. Well you know too much.

Courtney [00:33:03] You know too much as an anesthesiologist.

Lara [00:33:05] I do, but I think also and we could go down a whole another pathway of pain in terms of anesthesia but I think the experience of pain or the experience of anything in healthcare is so shaped by other experiences that you’ve had up until that point of your life.

Courtney [00:33:28] Not just medical ones, but outside of medical ones?

Lara [00:33:31] Everything. Okay. A lot of trauma. Sure. Right? Sure. A lot of trauma. You really see it come up when people are entering medical situations.

Courtney [00:33:41] It’s like ground zero for all of life, you know? Absolutely, absolutely. Is everything ending right now?

Lara [00:33:48] Yeah. Think about when you experience pain, if it’s something and you can say, oh, if I can just get through this, I know that it will stop and I will feel better. But labor, for instance, where I’m around all the time, it’s just gonna keep happening and happening and happening. And I think that the loss of that control or like the inability to see the end of it, people who have had trouble with trauma in the past, those people have a harder time coping with the pain of labor. And I I don’t think that, I don’t think that that’s any fault of theirs, but that’s something that we don’t think enough about, right?

Courtney [00:34:36] How trauma informs their patient experience. Right.

Lara [00:34:38] And what could we do better to make that easier for them?

Courtney [00:34:42] That’s good.

Lara [00:34:43] So I try to, I try to say things like simple things. This is going to be one of the last bad contractions that you feel. You’ve been doing this for so long, but you’re almost there, right? Because I think it sets up a perspective of it not just being this forever situation that somebody’s forced to sit through.

Mandy [00:35:05] When I do an endometrio biopsy, very different than labor, but some would liken it to that. I count down from 10. So that they know, as opposed to counting up, I count down. And then they know that when I’m done. When I get to zero, it’s done. So they know where the end of it is. Because it’s very uncomfortable, but I need a good sample. So I count down from 10.

Courtney [00:35:26] Interesting.

Mandy [00:35:29] Is there any threat to your field with AI?

Lara [00:35:35] So many exciting things happening with AI. I don’t know that it will ever be a threat. I think it’s gonna be really helpful. Maybe that’s too optimistic or rose-colored glasses for me to say, but can I give an example? Yes, please. We love examples. So right now, we have an uptick in maternal mortality in obstetrics across the United States. Not a secret. It’s out there and it’s very true. We could talk all day about why it’s actually happening, multifactorial, but hemorrhage is one of the things that continues to kill women in childbirth. And one of the things that one of my brilliant colleagues is doing is developing an algorithm that helps predict risk of hemorrhage in childbirth. And you might think, oh, I think I’ve heard of that happening before. You have, but the risk factors that we used to think were the most impactful might not be the ones that we really should be paying attention to. We may have been missing some. And we also have some factors that are dynamic, like if a woman gets an infection in her uterus across labor, right? That’s not something she came into the hospital with. It’s something that happened across that labor course. And so this tool that she’s developing with AI is reflected on our board that we sign out. And it tells us across that woman’s labor curve, because we could have 30 people laboring. It says, hey, room eight is now an extremely elevated hemorrhage risk. Do you have the appropriate things in the blood bank? Do you have the appropriate access in her? Have you talked to her about what it would look like? Would she be accepting of blood products? All of those things that, not that I would have missed those, but when we’re watching an incredibly busy board. It’s so helpful, right? And so that could be lifesaving. And so I think that it’s going to be a tool for us in, a setting where we are resource poor, I think it’s gonna help and kind of seal in some of those cracks. So I’m excited about it.

Mandy [00:38:07] I think they’re doing something similar in some ICUs across the country looking for early markers of sepsis before it develops. And so they can catch it and AI is pulling from the chart. and alerting the team before, even before things like a temperature goes up or a white count goes up or a blood pressure drops, early markers.

Lara [00:38:29] And you’re seeing, I mean, look at radiology.

Mandy [00:38:32] Oh, right. AI.

Lara [00:38:33] Yeah, big impact there. Man, it’s made a huge impact, huge impact. Just speed of results and looking closer. And just the ability to see things that maybe the human eye can’t see. Especially when you’re tired.

Mandy [00:38:45] Yeah. I feel like when I’m tired, the first thing that goes is, Yes, right? Right? You’re like, why is it blurry? What’s happening? I just got fired. Yeah, that’s awesome.

Courtney [00:38:57] Whoops.

Mandy [00:38:58] Yeah. So. It’s great. Speaking of things that I could get fired over, when I was in med school, and actually in undergrad, you know, there were things that I had to take, that I was like, I’ll never use this, and it’s pretty, it’s a good thing, because I suck at this, like organic chemistry and pharmacology. See, look, this is where I’m going, good. Yeah, so there were definitely things I was like, I’ll never use this, and then I’ll be in the OR with you guys, and I’ll hear you jabbering away all your little things, and I’m like, they’re using all of that. They’re using all of that chemistry. They’re using all of that pharmacology that I just threw in my trash, my brain trash. So do you think that anesthesia as a field definitely taps into more of those early courses that a lot of us just take, make the grade, and then flush, or no?

Lara [00:39:50] . I’m trying to think of it as a comparison to other fields. Maybe more the chemistry and pharmacology. Yeah, I’d never thought about that before, actually. See, you were like, I love that. There you go, self-selective. I actually taught organic chemistry. Did you really? I was a TA. Whoa! I love this. I have a C. But I love puzzles. Oh, yeah, how it fits together, you flip it, the chiral. Yes, I love puzzles. I can see that.

Mandy [00:40:30] We talked a little bit about this with COVID, but social media in general. Do you guys get an, do you feel some heat on you from social media or some trends that have happened in anesthesia from social media or just questions that you get that you’re tired of answering over and over because they’re popular from an influencer? Has that kind of moved into the anesthesia realm?

Lara [00:40:57] Well it did in the recent past with Tylenol and in use with pregnant mothers so that became very trendy and kind of a hot-button issue and so there was a lot of situations where we wanted to give a patient Tylenol, they desperately needed Tylenol, they were infected, high fever, not a good environment to be pregnant, right? And they were reticent to take the Tylenol. So that, you know, the simple things like that bleed through. And then also, I don’t know if you guys would have felt it as much as we did in anesthesia, but there was an article that came out that made the accusation that epidurals contributed to autism. I’m trying to think about how long ago that would have been now. Probably years ago, time’s flying. And a lot of the larger societies within my field, so well, within you guys’ field, ACOG, and then SOAP is the Society of Obstetric Anesthesia and Perinatology, and then the American Society of Anesthesiologists had to come out with statements and respond to the journal that published the article that you know everybody has their their views about how publications are selected and different in different journals and and I’ll leave that there but I think that I know, and you guys know, that a lot of those societies take into account all of the publications and all of the research and which research was done rigorously and was vetted appropriately and had the right statistical analysis. And it’s hard for the lay public to know that, right? Like if I wouldn’t have gone through all of the years of school that I’ve gone through, it would be impossible for me to interpret the scientific literature, right? Sometimes I still don’t know how to interpret certain statistical analyses, right? But I know who to ask and I know how to think about something being worth my consideration and something not. And so when things get very buzzy and trendy in social media, the blowback of that and we don’t have a lot of time to prepare, right? I think that SOAP, which is our main society, they responded like within 24 hours because they knew that it was just going to be.

Mandy [00:43:59] Oh, but yeah, they had to get ahead of it.

Lara [00:44:00] Oh, absolutely. Just because they wanted patients to feel like they had the data to make the right decision for them, right? Yeah.

Courtney [00:44:10] We talk a lot, we try, one of our main goals is to humanize doctors because often as a patient you feel this wall between you and the doctor and maybe a doctor that you go and see in a clinical setting is different because they care for you over a longer period of time. You mentioned that you have five to ten minutes to like build trust with someone. Do you feel, talk about how, if, if you feel the weight of what you are doing with patients, like you’re a human, so I’m assuming you do, and you went into it to care, you went into being a doctor to care for people. That’s, that was your, you know, you answered this call that you had on your life, but what, , what do you take with you? Yeah. How do you feel when, when you leave the hospital? What does that look like?

Lara [00:45:05] I think, man, I feel like it is such a privilege with what I get to do every day. And I think that, you know, I’m a believer. I don’t know that all anesthesiologists are believers, but I do feel like there are these moments that are very holy moments, right? And people will, show emotions right before anesthesia, right after anesthesia, the number of patients that ask for someone to pray with them before they go to sleep. It’s really profound and it crosses all lines, like different people in the operating room, different beliefs, different ages, different genders, everything, right? And I feel like it’s a great equalizer because I get to see people in their most human, basic form, right? I don’t know the road that they walk to get to that moment, but I’ve done it long enough that I can see that everybody is the same. We all bleed the same blood. We all experience the same pain. We’re all scared of the same things. I’ve cried with so many different kinds of people. There’s been high highs and low lows and to be able to share those moments with people, I don’t take that for granted.

Courtney [00:46:43] You know?

Lara [00:46:44] It’s, yeah.

Courtney [00:46:46] It’s very sweet. I’m like crying here. I wrote a paper one time, I don’t know if you’ve ever seen the movie Philadelphia. Have you ever seen that movie? It’s Tom Hanks, old Tom Hanks movies. He contracts HIV, AIDS, this was way in the early, that was an absolute death sentence, almost immediate. Anyway. I had a, he was a teacher who we got close to, and he passed away from lung cancer, and they let a bunch of teenagers, I don’t know why, go up there and see him in like his last days. And that was extremely impactful as a 16 year old. And so he was shriveled up in this tiny version of himself, no hair, pale as all get out, big dark circles, and struggling to breathe. and then I was in a class and we were watching Philadelphia and I’d never watched that movie before and that is exactly how Tom Hanks’ character, who lived a very different life than my teacher, just my teacher was just a normal, regular guy, but at the end of life, they both looked the same and that was a profound moment and I feel like that’s what you’re saying is when you get that close to birth and death, there’s a lot of equal playing fields that we all come to. And that’s impactful to hear.

Mandy [00:48:14] Well, on that note, do you flip the coins to the other side of something more fun? I think, actually, we’re going to move on to our last part, which is speed rounds. Oh, boy. Yes. Rounds. Rounds. That’s our pun. Medical pun. Which we’ll go through. And so these are just sort of short answers. They don’t have to be one word or anything. If they want clarification, we’ll ask, because sometimes it’s nice to know the context, the back story. But yeah, just kind of off-the-cuff things. Are you superstitious? I don’t think so. Oh, I thought for sure you would say that. I don’t think so. No. OK. Good for you. Fine. Live that way. Which other specialty do you have to ask for help the most from?

Lara [00:49:07] I think OB, just because I’m there the most. Yes, absolutely. OB and GYN. You both are obstetricians, right? I mean, yeah. We’re sort of reformers. We’re practicing retired. Emeritus. Heels on. Non-denominational.

Mandy [00:49:29] Non-denominational. I’m going to start calling myself that. , what’s a word or phrase you end up saying multiple times a day?

Lara [00:49:43] Oh, there’s so many little scripts that we say over and over again. Yes. I think if one of my trainees was here, they would tell you that I am always saying you’re safe. I say it when someone’s waking up. Even if I know that they’re not conscious yet, I will start saying it way before I think that they are, just because I want them to truly feel that way. Or if they are awake, in a C-section. I say it all the time. You are safe. Yeah. That would be very reassuring.

Courtney [00:50:20] Yeah, that was that little tap on my shoulder. I’m telling you, that man just put it on there, didn’t take it off. It was nice. It was very nice. Good.

Mandy [00:50:28] Who in your inner work circle could you not live without?

Lara [00:50:32] Oh, I mean so many people. I am so lucky. It really is a family that I work within and We were just at our national conference, and so many people came up to us, and they were like, man, you guys have a really great thing. And I just feel like I practiced amongst some of my closest friends. And it’s because when you practice in medicine, you go through such intense emotions that it forges these bonds, right? My husband is always like, Man, I don’t have friends in my office like you have. I would never tell the guy that sits in the cubicle next to me what the people at your work know. But it’s such a beautiful thing too because I get to come to work and and do amazing things with people that I really, really am lucky to be around. So I can’t name just one.

Mandy [00:51:43] Okay, I’ll let you slide. Alright, this next question’s for the med students in the audience. How many hours a week do you work? Okay. Like, clinically? Like, just every time you do something that’s work-related.

Lara [00:52:02] because I wear an administrative hat, oftentimes when I leave work, I am going to go home to my mom job, and then after that job, I’m gonna do a little bit more work. And that can happen on the weekends as well. And I think a lot of people are like, well, you need to learn how to draw a line in the sand, and make boundaries, and you know. decide that you’re just not going to work on your day off. Some of it I do because I know that it makes the days when I’m at work easier digestible. Yeah, right. And so I, I think it’s an important thing for these medical students. to think about, because when I was deciding what I wanted to do, I did not think about hours, or if I was gonna have a clinic, or what, if I wanted to write notes. Actually, I did think about that. I hate writing, like, long notes, so that… So no internal medicine for you. Yeah, that’s a good thing with anesthesia. Our notes are very short. Succinct. Only the most important details. To the point.

Mandy [00:53:14] Okay, that’s a great one. I know, that’s okay. I mean, I have an idea if that’s all right. She doesn’t have to answer that. If you could ask your boss or chair for one thing, what would it be? And they had to give it to you.

Lara [00:53:31] She’s gonna say she doesn’t wanna answer that question. I’m not following the lightning round rules. That’s okay. Oh man.

Lara [00:53:49] It could be big or small.

Lara [00:53:50] There’s so many. There’s so many.

Lara [00:53:52] I would love some creamer in the surgeon’s office. Oh, right, yeah. Really, Max.

Lara [00:53:56] Is it not an anesthesia text? Max. Yeah, well, I’m just thinking, in my mind, I’m like, well, I could ask for that, but that’s not his… It’s not his problem that he can’t have it. I think inpatient interpreters constantly. I want every person that needs an interpreter, I want a live human being there the whole time.

Mandy [00:54:26] It’s already so stressful and then if you didn’t speak the language. That’s horrible. Another layer of complexity.

Lara [00:54:37] And fear. A couple weeks ago I did seven Caesareans. And six of them, I needed an interpreter, and it was four different languages, and none of them were in person, and multiple disconnections, had to call back, and I just feel for the patient, because I can’t imagine, well, I mean, we can all here imagine what it’s like to do a surgery in your own language, but then imagine in a different language. Holy cow.

Mandy [00:55:12] I can do that. That’s an excellent answer. What other medical specialties gross you out? Just FYI, your specialty grosses us out. I’ve been mentioned multiple times.

Lara [00:55:26] Oh my gosh, because of saliva? Yes, but it’s so much more than that.

Mandy [00:55:33] It’s the amount, the stringiness.

Lara [00:55:34] I mean, you have some nerve.

Mandy [00:55:38] We fully admit that that is a very bizarre comparison.

Lara [00:55:46] With the amount of things that I’ve seen you with your hands in. Hair, teeth, like, I mean.

Mandy [00:55:55] Okay, all right, all right, so I’m getting judgy. Okay, all right, what crosses you out?

Lara [00:56:00] I cannot do injuries to the nail bed, whether it’s your toenails or your fingers. I’m not even gonna talk about it anymore because I can’t. No way. So I guess podiatry? I can’t do that.

Courtney [00:56:18] It smells like feet in there. We’re gonna get a podiatrist on here and I’m gonna ask that question. The one time I went I was like, This entire section of the hospital smells like feet. What is happening? It was horrible, horrible, horrible. Okay.

Mandy [00:56:36] Side note, when I went to cardiology one time, because I had a weird thing happening, that waiting room, every person in there had their phone on loud, audio. And you can imagine what was the predominant generation if they were all on their phones. So I was like, yes, very loud, and all talking loud. So I was like, all the games were loud. So every waiting room has its own thing, I guess. All right, would you encourage your children to pursue a career in medicine?

Lara [00:57:12] You have to know my children.

Mandy [00:57:15] If they wanted to.

Lara [00:57:16] Yes. And when my husband is more in finance, and so we have very different lives. He is always telling them that when mommy comes home, she feels like she has really helped people. And and had an impact in that if she wasn’t there someone would have had a much worse day He says he can never say that and so I think he’s made me see that side of things, you know that when I walk away I I can genuinely say that I made people have a better day than if I wasn’t there and so I I give that a lot of weight in my life, and so if they can have that, I would want that for them. That being said, there’s many different little small choices that can make things better or worse. What a perfect guide you would be.

Courtney [00:58:18] Maybe don’t go so heavy on that.

Lara [00:58:20] Yeah, exactly. And I would love one of them to be a dermatologist. Wouldn’t that be wonderful? Are you going to get one of them on?

Mandy [00:58:28] Yes, oh yeah, let’s do it. We do need a dermatologist.

Lara [00:58:33] I love a dermatologist. Do you have a joke about your area of medicine? The, yeah.

Lara [00:58:42] Can you tell? I’m sure it’s clean, it’s you. It’s just silly, it’s silly, but it’s my husband. I’ve said my husband a lot and I really usually don’t talk about him that much. Anyway, he like, when someone’s like, oh, what do you do for work? And I say, oh, I’m an anesthesiologist. He’ll come right up and he’ll be like, she puts me to sleep every night.

Mandy [00:59:05] Okay, that’s kind of adorable. And I’m like, okay.

Courtney [00:59:10] After like 15 times, we’re like, . Here he comes, here he comes. It’s his favorite joke. That’s funny. Okay, our favorite question, well, my favorite question may not be theirs. If you could do any job in the world, outside of medicine, and you would still support yourself, you wouldn’t have to go back and do training and all those kinds of things, oh, I feel like you have it. What would it be?

Lara [00:59:32] I would be somebody that you could bring your ancestral lines and information to, and I would track down your genealogy.

Courtney [00:59:41] Oh, cool!

Lara [00:59:42] Wow, okay!

Courtney [00:59:44] What is that, a genealogist? I don’t know, is that a word? I guess, I don’t know.

Lara [00:59:49] That’s what I’m gonna do when I retire, is just go back. and just find it and travel to those places and look in the dusty books. I just love that stuff. I’ve done little bits, but when you’re in training, you’re younger, you’re like, everything you do for fun like that, you feel guilty that you should be reading about organic chemistry. But I’ve done little bits of different things.

Courtney [01:00:18] Where have you traced your family to? How far back can you go?

Lara [01:00:23] So we, my mother was a McNamara. Okay. And so she is Irish and then on my dad’s side we have a lot of German and then on my mom’s dad’s side Norway. Okay. And then the other side Transylvania. Oh, you’re a vampire. I’ve been there. Blood drawing.

Courtney [01:00:43] See how far back it goes? It’s funny. We were destined. It’s funny. That is so funny. Well, is there any last thought that you would want people to know about anesthesiologists, about your role, about health care in general? Just any kind of wise words or anything you’d like to share?

Lara [01:01:05] I think the stories that you’re going to read online, because everybody’s gonna read stories online these days, are either gonna be the absolute worst, most terrifying stories, or they’re gonna be the absolute best stories. And there’s so much in between. And that doesn’t get given a voice. And I, We take care of so many different people. People and the people that are trying to take care of you are genuinely good. And at the end of the day, they are not there because they want to hurt you or mislead you or trick you in any way. We all are doing the best that we can. And we truly want you to walk away with just the best experience possible.

Courtney [01:02:05] so great yeah thank you so much for being here absolutely yeah we appreciate you being here we appreciate all of you listening and we want to remind you you can follow us on instagram and we will be back soon next episode bye everybody

Mandy [01:02:18] This podcast is intended for informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. The views and opinions expressed by the hosts and guests are their own and do not constitute medical guidance for any individual case. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or health concerns. Never disregard professional medical advice or delay seeking it because of something you have heard on this podcast. By listening to this podcast, you acknowledge that the hosts, guests, and producers are not responsible for any decisions or actions you take based on the information discussed.