For many people, going under general anesthesia is the scariest part of having surgery.
You trust that you won’t wake up unexpectedly in the middle of surgery, and that when it’s over you will wake up – without being in unbearable pain.
Although you do get to choose your plastic surgeon, you don’t get to choose who does your anesthesia and you might not even meet them before the day of surgery.
On this episode you’ll meet Sarah, the intensive care nurse turned CRNA and Dr. Houssock’s trusted partner in the operating room. With each and every patient in the operating room, Sarah and Dr. Houssock do the profoundly important dance of surgeon and anesthetist.
Find out why our complication rate is so low, what happens when patients don’t prepare themselves adequately for surgery, and the single most important factor to a smooth operation.
Read more about Baltimore plastic surgeon Dr. Carrie Houssock
About Perfectly Imperfect
Hosted by Baltimore plastic surgeon Carrie A. Houssock, MD and her all-female team, Perfectly Imperfect is the authentically human podcast navigating the realities of aesthetic medicine for people who live and work in the DMV.
Got a question for us? Leave us a voicemail at theperfectlyimperfectpodcast.com
JEV Plastic Surgery is located off I-795 in Owings Mills, Maryland at 4 Park Center Ct, Suite #100.
To learn more about JEV Plastic Surgery, go to jevplasticsurgery.com
Follow Dr. Houssock on Instagram
Follow the JEV Plastic Surgery team on Instagram
Perfectly Imperfect is a production of The Axis
Transcript
Dr. Houssock (00:04):
You are listening to another episode of Perfectly Imperfect.
Dr. Houssock (00:09):
All right, well, hi, Sarah.
Sarah (00:11):
Hi, Dr. Houssock.
Dr. Houssock (00:12):
Welcome to the Perfectly Imperfect Podcast.
Sarah (00:15):
Thanks for having me. I’m excited to be here.
Dr. Houssock (00:18):
I’m so excited that you’re here. So our big topic today is a big one for our patients, and people do a lot of research to trust me. They do a lot of research figuring out what plastic surgeon they want to go to and if they’re capable and competent, and whether the outcomes, the results are what they want. But we know that this takes much more than just me and that we are a team. And there’s no question that in our practice that is on the forefront. And there goes without saying that one of the most important people is the person who’s delivering the anesthesia. And though we know that and patients think about it, we don’t talk about it a lot. So Sarah is our CRNA. She has been working together with me for, oh my gosh, are we five or six years now? Have we’ve been together?
Sarah (01:14):
It’s right around there. Yeah. And I love working with you.
Dr. Houssock (01:18):
I love working with you too. And probably, I mean, I’ve done most of my cases over the last five or six years with Sarah. The only time I’m not with Sarah is if I’m in an emergency case in the hospital in the middle of the night, even though I wish I could take her with me or if I’m operating on her, which we’ll get to. Or other than that, if Sarah, God forbid, takes some time off. So Sarah and I are really intimate in what we do for a living, and so I know you really well, but why don’t you tell everybody else a little bit about your background?
Sarah (01:54):
Sure, sure. Hi everybody. My name is Sarah. I’m a CRNA. What is a CRNA? That’s a certified registered nurse anesthetist. I absolutely love my profession. I would like to make a little bit of a comment about what you had said earlier about me being the most important person in the room. I object to that because the patient is.
(02:19):
However, I do agree with you, the patients don’t get to interview me. Our anesthetic this morning, I actually had mentioned to her, Hey, you get to pick your surgeon, but you don’t get to pick your anesthetist. Let me tell you a little bit about myself. I’ve been giving anesthesia now for over 15 years. I’ve been a nurse to include that time for, oh boy, 24 years. So most nurse anesthetists are either mastered prepared or now moving closer to date, doctorate prepared nurses, advanced practice nurses, coming to the field of anesthesia with a background in intensive care, which was where I came from. So what I can tell you though about nurse anesthetists specifically is I’ve probably, I cannot recall ever meeting a nurse anesthetist that did not love their profession. I’m not an anesthesiologist. I’m a nurse anesthetist, but I do work very closely with anesthesiologists in other facilities and have found the similar response to them. We love our patients and we love to take care of people. So I give you that to know about anesthesia providers.
Dr. Houssock (03:41):
I think it’s interesting because we make jokes in medicine about how anesthesia, just on the other side of the curtain, there’s this curtain that’s up between the surgery and what’s happening there and what’s considered at the head, keeping the patient safe and breathing. And it’s always been funny to me about when it comes to that, especially in our relationship, Sarah and I, we work in tandem. You might as well consider that drape to be see-through, because we really do have a relationship where we’re working together, the entire case. Love it.
Sarah (04:18):
Yeah, yeah. And communication is key between the surgeon and the anesthetist. It makes things go very smoothly when there’s a communication there we have together. So I appreciate that.
Dr. Houssock (04:30):
And it’s interesting. So I don’t think it’s probably very rare for the relationship to be at an even deeper level for Sarah and I, in a sense that Sarah herself has been the person who’s put me under anesthesia.
Sarah (04:45):
And you’ve been the one to operate on me.
Dr. Houssock (04:47):
So we really come full circle. If you ever wonder the experience, we really understand it. And there’s nothing like that. I mean, I obviously can’t stress enough that our patients, their safety and their health is the most important thing to us. Sarah and I are so, so concerned about how patients are going to go into the OR safely and leave safely. And when I decided that I was going to have my surgery, it didn’t even occur to me. I knew 100% that I was going to be in good hands and safe. And sure enough, it was the most peaceful, you know, patients ask all the time, what is it like? It’s the most peaceful, wonderful sleep. And maybe Sarah, you could talk a little bit about how you make that happen.
Sarah (05:34):
Sure, sure. Well, the beautiful thing about anesthesia is, for me, is that I get to have a different experience every time I give an anesthetic because there’s no exact same case and there’s no exact same patient or the exact same day. So in that respect, anesthesia has many different facets to it. One thing that I can tell you about Dr. Houssock specifically and our team, myself included and our nurses, is that we take it very seriously to have the adequate preparation for surgery, which would include primary care physician, history, and physical blood work to make sure that everything’s status quo, other possible physicians involved, to just make sure that we are not missing anything prior to the day of the operating room. So there’s a lot of preparation that goes on behind the scenes before the patient even comes in. We know our patients pretty well by the time they even walk in the door as far as their medical history and the process. We do general anesthesia for our cases. We do do mostly TIVA though total IV anesthesia. And that’s a really beautiful anesthetic. And there’s a couple of reasons why we do that. One, most of our patients specifically coming for plastic surgery, it’s an elective surgery, we’re in an outpatient facility. We’re not in a hospital room environment. So most of our patients are pretty healthy, and we have to keep a tight control on that for safety reasons, because these are elective surgeries.
Dr. Houssock (07:29):
Well, I mean, I think what you’ve come down to is really about how even though we are a surgery, these are still patients who are choosing this procedure. And so whenever you think about a surgery that is being chosen, you want to make the environment obviously as safe, but also as pleasant as possible, and we’ve taken a lot of time to do that. And one of those ways, of course, is keeping them safe and the preoperative and preparing, but then how we go about giving the anesthesia needs to be in a way that is as much as they need, but not more than they need, if that makes sense.
Sarah (08:07):
Absolutely.
Dr. Houssock (08:07):
So we want to be safe and we want to make you comfortable, but we don’t want to put you at any additional risk than you already might be under just by going under anesthesia to begin with.
Sarah (08:18):
It’s funny that you say that. I had a patient the other day, they said, so you’ll give me my anesthesia and then are you going to be there the rest of the time for the surgery? And I said, well, it’s not like a one and done kind of thing. It’s more of a dance between me, the surgeon and I. It’s a continuous process of administration of anesthesia. It’s a continuous process of watching your vital signs. Every breath you take, every heartbeat that you make, we’re watching.
Dr. Houssock (08:48):
Yeah, you’re only in charge of the breathing and heart rate. I mean,
Sarah (08:50):
Details, details.
Dr. Houssock (08:51):
So simple But it is, and we joke about it, but it really is that way. And Sarah and I are talking the entire case. We are chatting the entire case. She’s letting me know how things are going. I’m letting her know how things are going. Depending on what part of the surgery I’m on, I will allow her, she allows her time that she needs to adjust her anesthesia. It’s a constant dance. And I truly feel that any relationship between anesthesia and surgeon that isn’t that way is not giving the best outcome for the patient. So I feel like our communication is, it’s not just a nice added bonus. It’s a necessity.
Sarah (09:30):
Absolutely. Absolutely. And the TIVA aspect, the total IV anesthesia, the reason why we do that is it’s just been proven to have a little bit smoother of an anesthetic course. There’s not the inhaled anesthesia, which causes a lot of nausea and vomiting. We optimize our numbing medicine. Dr. Houssock does a wonderful job of infiltrating the areas that we’re going to operate on with numbing medicine preparation for any surgical incision. So before the actual surgical incision starts, the patients, I’ve gotten to meet the patient, I’ve gotten to talk over their medical history with them, I’ve gotten to answer any questions about the process. I’ve gotten to kind of set the expectations of what to expect for the patient. This is what you can expect. We’re going to walk you back into the operating room. It’s generally a little colder in there, but we’re going to tuck you under some warm blankets, and you’re going to have on a blood pressure cuff, a heart rate monitor, an oxygen monitor.
(10:30):
We’re going to give you some oxygen, and then we’re going to continuously give you medicine, and we’re going to be watching you and making sure that you’re breathing perfectly. And there’s some questions may come up about awareness. Somebody, there was a terrible movie out a couple of years ago that brought a whole slew of questions to me of, am I going to remember this? Am I going to, but there’s many ways for us to know if the patients need more anesthesia or if we need to back off a little bit on the anesthesia. And that takes with skill and practice and correct monitoring. All these things make for a better, pleasant experience. Now with that being said, medicine is medicine and we have everything available in case of an emergency. So we have the crash cart, we’ve got the AEDs, we’ve got the breathing tube, we’ve got the high flow oxygen. We’ve got it all for resuscitation efforts and very skilled to use it, should we need it. What I’ve found in my experience though, is that the preparation that we take before the day of surgery changes, really just sets the course for a smooth anesthetic. And that requires participation on the patient’s part too. There’s a lot of things that we ask patients to refrain from doing prior to the day of surgery, things as smoking, that’s a huge one for us, a huge one. And everybody thinks, well, what’s so problematic with smoking?
(12:16):
I like to kind of teach people a little bit why we ask you not to smoke so that you kind of know we’re not just trying to make you miserable here. But what we’ve learned through science in the study of medicine is that when we inhale nicotine, it binds to the oxygen carrying blood cells in our bodies and our blood cells can take the oxygen to the proper places in our body, or it can take nicotine. It doesn’t actually have the capacity to hold both. So if you’re smoking, you’re actually diminishing the amount of oxygen that gets to every single ounce of your tissues in your body.
Dr. Houssock (12:53):
And neither of us like that.
Sarah (12:55):
No, because we want you to heal. We don’t want you to have wound issues. We don’t want you to also be coughing all the time while Dr. Houssock doing a tummy tuck. We don’t want you coughing and not because it’s inconvenient for us, but because it’s dangerous for the patient. And it can lead to a sequelae of respiratory events that we do not want for our patients because we care.
Dr. Houssock (13:22):
Is it safe to say, Sarah, that when we look at your preoperative sheets, so we hand those to patients when they’re scheduled for surgeries, is it safe to say that every single one of those rules on our preoperative sheets have been well thought out and have been decided upon through experience and data?
Sarah (13:45):
Oh, yes. Oh yes. The abstaining from smoking, that’s the biggest one, I’m telling you, that’s the biggest one. Abstaining from drinking, drinking alcohol. Why does that matter? One, most importantly, it thins the blood. And we’re in an outpatient setting. We don’t want our patients to get into a situation where they’re having excess bleeding from an elective procedure. So alcohol intake is something that we ask people to refrain from for four weeks prior to surgery. And there’s reasons for all of this.
Dr. Houssock (14:21):
And it’s the truth. We are probably some of the strictest sticklers when it comes to that. But I would also like to say, and I feel very confident in saying that our risk rates and our complication rates are also exceedingly low because of it. And because we are working on elective surgery that Sarah and I have chosen to do that we love to do, we don’t see a reason to put you at risk anymore than the average because it’s not necessary. It’s not necessary surgery. So Sarah and I love operating, but we have both, one of the things that I think sets us apart in our relationship is that we really see eye to eye when it comes to when we have to cancel a patient. And that’s hard. Neither of us want to cancel you. We hate doing it. We know how hard it is to schedule, but we also really, really care about our patients.
Sarah (15:15):
Bottom line.
Dr. Houssock (15:16):
Bottom line. And at the end of the day, we both want you to succeed safely, and we will both sleep better at night knowing that we’ve done the best and healthiest decision for you. And sometimes that means us making a hard decision for you. And that is hard. And once, probably about once a year, would you say, Sarah, we’ve had to abort surgery due to some particular reason when we’re initiating anesthesia. Would you say it’s about once a year?
Sarah (15:44):
Yeah.
Dr. Houssock (15:44):
And it’s funny because even though we both make that final decision, we look at each other in the eye and we know we’re doing it before we even say anything. We know. I mean, and it happens. And so if that happens to a patient as sad and as hard as it is, I will tell you that the vast majority of patients are so grateful that we cared more about their health than putting them at risk. It always works out.
Sarah (16:09):
Absolutely. It’s not about the money. It’s about the patient. It is 100% Dr. Houssock, and I can speak for myself only, but I know Dr. Houssock and I both did not get to this profession for any other reason, that we love our patients. We love taking care of people. And yeah, I respect you so much for just committing to having an environment that’s safe, that’s well prepared. I’ll tell you, if you get the chance to let Dr. Houssock operate on you, you’ve chose an exceptional surgeon because you don’t get to see the background work that’s put in. She goes above and beyond for her patients. That’s why I chose her to operate on me. And there’s plenty of lovely plastic surgeons in our area, but I have a specific respect for Dr. Houssock in the way that she practices.
Dr. Houssock (17:08):
And that obviously goes without saying that I feel the same way about Sarah, and I love that you’re able to get on here with us and show a little bit of yourself, because I think you’re kind of that X box unknown. And I often will tell patients, I actually very often, especially any patients who are nervous about anesthesia, I always offer that you will meet them, speak with them, whatever they need. And I know that you would in a heartbeat, in a heartbeat. And even in the morning of patients will describe feeling just at ease once they meet Sarah because they get to speak to her just like she’s speaking now. She is very comfortable. She loves what she does. She has no reservation about what her expertise is. And in addition to that, she makes you feel comfortable. And that is very rare, I feel when it comes to someone who’s the anesthesiologist behind the curtain. Tell us, just before we go, Sarah, just a little bit about your outside life and what you do when you’re not in the OR.
Sarah (18:15):
Well, we have two kids, and we are right in the thick of the preteen years, which believe it or not, I’m loving. We’re doing lots of sports. We’re doing lots of traveling for sports. I love to be outdoors. I love to do some water sports, some boating. We like to vacation with our kids, but some days going to work is just a delight for me because I get to get away from that motherhood.
Dr. Houssock (18:49):
I totally get that.
Sarah (18:50):
I tell you what, given anesthesia sometimes is easier than parenting a preteen, but there’s another story for you. <laugh>
Dr. Houssock (18:59):
<laugh> I’m telling you. And we are a room, we are a room and a practice full of women, and we are, a vast majority of us are very new or young parents and have kids who are still in the nest. And there is something really great about that too, when it comes to our patient population and the way that we get along as a team. It really is one big happy family. I think that is so cliche, but it really, really is. And just sitting here, I spend several days a week, many hours with Sarah, and I’m not kidding, just sitting here doing this with you makes me just love you and just appreciate you even more. I just really love you so much. And our patients will love you too. I can’t wait for them to meet you.
Sarah (19:49):
Yes, yes. And what do they say about, we’re kind of similar professions. What do they say about a good plastic surgeon and a good anesthetist are ones that you barely ever knew were ever there?
Dr. Houssock (20:02):
Yeah.
Sarah (20:03):
That’s what we aim for. We aim for no sore throat. We aim for no nausea. We aim for no pain.
Dr. Houssock (20:11):
We want you to forget us.
Sarah (20:14):
Yeah, we, unforgettable.
Dr. Houssock (20:19):
Never forgotten, but never noticeable. I think that’s one of the best ways to say it. And it’s true. You don’t want to, it’s just the coolest thing. I mean, we create magic back there, I don’t care what anybody says. Well, Sarah, thank you so much for being on today.
Sarah (20:34):
Yeah. Thanks for having me. This is so exciting. I’m so glad I could be a part of this. This is perfectly imperfect podcast.
Dr. Houssock (20:42):
Amen.
Sarah (20:43):
Yeah. Carry on Dr. Houssock.
Dr. Houssock (20:43):
Carry on Sarah. Bye.
Dr. Houssock (20:46):
Perfectly Imperfect is the authentically human podcast navigating the realities of aesthetic medicine. JEV Plastic Surgery is located in Owings Mills, Maryland. To learn more about us, go to JEVplastic surgery.com or follow us on Instagram at @drcarehoussock, spelled D-R-C-A-R-E-H-O-U-S-S-O-C-K, or just look in the show notes for links. If you enjoyed this episode, please share it and subscribe to Perfectly Imperfect on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcasts.