Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
What Happens When You're Asleep: A CRNA Reveals Operating Room Secrets
Peek behind the surgical drape in this eye-opening conversation with Jared Barton, a Certified Registered Nurse Anesthetist (CRNA) with an extraordinary career. Did you know that 80% of all anesthetics are administered not by doctors, but by nurse anesthetists? Barton reveals this surprising statistic while taking us through the intense world of operating room anesthesia, where life-and-death decisions happen behind a paper screen that separates the anesthesia provider from the surgical team.
Barton shares his remarkable journey through the "militant" training program at the University of Alabama at Birmingham, where a single mistake meant immediate expulsion, and his subsequent work in high-stakes environments including level one trauma centers. With striking candor, he discusses the reality of watching patients' vital signs "second by second by second," and the intuition that develops after years of practice – that sixth sense when something doesn't look quite right.
Perhaps most impressive is Barton's perfect track record: he's never lost a patient throughout his entire career. While he modestly attributes this to luck rather than skill, his descriptions of managing critical situations – pushing blood products with both hands during massive hemorrhages, anticipating problems before they become critical – speak to the expertise that comes only with thousands of hours of vigilant practice.
The conversation also explores the evolving landscape of healthcare delivery, with ambulatory surgery centers creating even more demand for CRNAs, making this a highly secure career path that's unlikely to be replaced by automation or artificial intelligence. For anyone curious about what really happens when you're under anesthesia, or considering a career in healthcare, this conversation offers rare and valuable insights from someone who has spent decades keeping patients alive during their most vulnerable moments.
Hello, this is Jason Edwards and this is Doc Discussions. I'm joined today by Jared Barton. Jared is a CRNA Jared. How are you doing today?
Speaker 2:I'm doing good. Thank you for having me.
Speaker 1:You bet buddy. And now? What is a CRNA? Can you explain that to people?
Speaker 2:Sure, it is the nurse equivalent of an anesthesiologist. In fact, one of our names that we go by is a nurse anesthesiologist. We One of our names that we go by is a nurse anesthesiologist. We do the exact same things. We can do everything that they can do, except for writing scripts, obviously, but we do anesthesia of all different types. Whatever is needed, we can do. Some states are actually without anesthesiologists, so the hospitals are completely void of any anesthesiologists, only CRNAs.
Speaker 1:And rural hospitals sometimes will just have a CRNA. Is that right? Yes, Mm-hmm.
Speaker 2:Yeah, and, like I said, certain states are what we call, in the industry, free states.
Speaker 1:Okay, sure.
Speaker 2:There's no requirement for a doctor Within the hospital like at St Luke's. Here, where I am, you know, I have free run of. I can order any drug, pretty much I want, but I have to order it under a medical doctor. Got you.
Speaker 1:Yeah, and so it's.
Speaker 2:It's to me, from the outside, looking in, it's a little bit odd, because it seems like there's a I don't know if I would use the term turf war, but there's there's some kind of haggling over who can do what between the anesthesiologist and the CRNAs, but they also work with each other and are friends, and what you'll find is like where I trained in Alabama, all of your residents are trained by the CRNAs, so your older anesthesiologistologists it wasn't that way, and so there is a big divide because they still really want to hold on to every bit of you know more power that they have over us, whereas the younger generation I see that's coming up being trained by the crnas have a lot of respect for the crnas. Yeah, we, we study the same books. We say we have to take national boards just like they do. It's. You know, we do blocks, we can do you know anything. Anything they can do other than we.
Speaker 1:We don't have the power of the pen when it comes to scribs yeah, and crnas have been around for a long time um somebody was telling me that the, the training regimen, actually had kind of a military origin and I don't know the whole origin story of it, but I know it's a very regimented training program.
Speaker 2:It is and, in fact, your nurse care. They weren't nurses like that, obviously, but nursing for anesthesia came first before medical doctors of anesthesia got you. So, um, you know that would tell whatever that means. Yeah, you know, the I never. I never find really that the there's a lot of and again, I find that it's it's wherever, it's where you go, because there's a lot of. Uh, most places where you go in in the settings, the doctors are supervising, okay, they don't actually do any anesthesia, yeah, whereas the CRNAs do all of your anesthesia. And if you're a patient, a lot of people don't recognize this, but I would say I believe the last time I saw it was 80% or better of all anesthetics are provided by a nurse anesthetist.
Speaker 1:How about that?
Speaker 2:Yeah, 80% or better of all anesthetics are provided by a nurse anesthetist. How about that? So the likelihood of you having a surgery and having what you thought was an anesthesiologist is probably not an anesthesiologist. You may have met him and he might have asked you questions, and then, when you got to the room, it was a CRNA doing your procedure. Yeah, and that's very common.
Speaker 1:In most of the cases I do, it's a CRNA, like over 90%, and a lot of times it's you, and I always enjoy seeing you in the room and so the yeah. Now let's go back to you personally. So what has been your kind of medical history up to this point, as far as where you first started working or where you went to school first?
Speaker 2:So I went to the University of Alabama at Birmingham, which is UAB. It's a huge medical facility in downtown Birmingham. It's the Southeast Trauma Center, so they have their own jet airplane service, wow, and so it's huge. I mean, when you say big's big, it's gigantic, big um, well, well, respected at very large um, that's where I went for my nursing and then nursing school, nursing school and then subsequent anesthesia school, um, you, you learn so much by going there.
Speaker 2:It is something where you spend a lot of your time the night before reading because it's like what is this procedure? I have no idea, because they do so many one-offs, yeah, so many rare procedures you won't see anywhere else. But the school that I went to was very militant, like you said, very strict. I mean nothing like what I've seen. I've been there, I've been in Kansas and I've been here in Missouri and just seeing the kind of what is allowed from the students or what is accepted from the students is quite different from what it was, and it may be also a difference in time. This is quite a while back, yeah, different eras.
Speaker 2:When I was coming through, nothing was accepted other than the you know, the best of the best pretty rigid very yeah, um which which most people uh, it's like not fun to go through, but most people find effective, very effective, yeah, very effective um, in fact, I believe that's what really gave me a leg up on a lot of other places is because you'd be so well known and I think they are so well known because you do have that kind of fear factor, because they don't mess around. If you are kicked out of a room for any reason, you are out of the program. Okay, so you're done. One strike.
Speaker 1:Yeah, are you from that area? Yes, and do you know a guy named Gene Bartow? Yes, so he was the basketball coach at UAB for a long time, and I believe it's his nephew, is actually a surgeon in Columbia Missouri. Okay, real nice guy named Kevin Bartow.
Speaker 2:Oh, did not know that.
Speaker 1:But I went to high school with him, yeah, and so, and actually him and Dr Boston were, I think, co-residents together. The basketball arena is the Gene Bartow. Is that right? Okay, yeah, and then and then. So after nursing school, did you work as a nurse or did you go straight into CRNA?
Speaker 2:school. No, you can't, you have to put in your time. So there is a requirement for two year minimum. And it has to be ICU and it has to be certain ICUs, okay, and so not just any ICU like NICU, your neuro, nor your infants, gotcha. It's an adult ICU, correct? And it can't be. You know, I was on the SICU surgical side, where there's a medical MICU and they generally don't take people from that side either. They's a medical MICU and they don't. They generally don't take people from that side either. They won't, they won't. Cic it was cardiac, gotcha, they big on that but that and surgical, because obviously what we do is surgery, but um, that's generally the two pulls that they they want to draw from and so you did a couple years of that and then went to.
Speaker 1:I did.
Speaker 2:I did exactly two years almost to the day. And not that there was anything wrong with it, I was just. I worked in the ICU in a very challenging hospital in the west side of Birmingham, which is the most dangerous side of Birmingham, so we got a lot of gunshots, a lot of trauma, lots of trauma, yeah. And so I think that, plus, I was a little bit older getting into this, so I wasn't young, but I wasn't old. But at the same time, they look at that too, because you're more mature.
Speaker 1:Yeah, and, and you know the ICU, oftentimes you have younger nurses there just because the hours are long and it's and it's and it's. You know that's. I think there's some thrill in, you know, working in that high acuity care. As we get older, the desire to chase that tends to fade a little bit.
Speaker 2:My first job out of anesthesia school was a level one trauma center, so you know I cut my teeth on that pretty hard.
Speaker 1:Which is great, oh yeah.
Speaker 2:I mean, I learned. I learned like you wouldn't believe the stuff that I learned, seeing some of the stuff I'll never see again. Hope to never see again, yeah, but now I've done it so long now there's no way I'd go back to that.
Speaker 1:And you know, for better or worse you get desensitized to some of these really crazy situations. You know somebody comes in with any kind of trauma. You know you can have horrible traumas with a car wreck, a dog, bullets, knives and, and it's good, in a sense, to become somewhat desensitized to that. So you kind of have a cool head and that's a good way to kind of start your training off. So, cause, cause, it's probably not very often, but every once in a while I'm sure things come up at work that are kind of, uh, you know, gets the heart racing a little bit. Oh yeah, absolutely. Having that experience, you know, helps you keep a steady hand to the till.
Speaker 2:There was always the thing that was always really hammered to us in school, and that was always always everything's okay and so only when it's not okay is when you call for help.
Speaker 1:Yeah.
Speaker 2:And so that meaning is that the doctors really never know what's happening. They're focused on what they do and they're trying to get in and get what they are going for the surgeon.
Speaker 1:And get out.
Speaker 2:Yes, yeah, and then our yes, yeah, and then our job is basically make it so that the patient lives through this procedure. And so when you start seeing things such as you know, you see blood pressures that aren't that great or heart rates that are getting a little weak, you get blood pressures that are real soft, that type of thing you know that they're bleeding. You can hear it. There's all these. You know you're really maximizing all of your sensory yeah and and everything you can.
Speaker 2:You can do so much, and so that's when and a lot of the, a lot of the surgeons they'll they can tell, because they'll start hearing a lot of work happening behind that screen and you can hear the beeping.
Speaker 1:you know you can hear like we can all hear the beeping of the heart rate, and so you know if things are changing.
Speaker 2:But I know, even like if I'm, if I'm just getting set up and kind of ready for my next case or whatever, a lot of times they'll sort of be like Jared, are we okay? Yeah, Because they know I'm, I'm, I'm I% of the time. I'm going to fix it, I'm going to make it where it doesn't matter. So you do keep doing what you need to do.
Speaker 1:They can focus on what they're doing, right, yeah?
Speaker 2:And that's what that's. My job is to help the surgeon as much as it is to help the patient.
Speaker 1:You know the I part of my training was in general surgery and you, when you go through tough situations with people, I feel like you really do form a close bond. Whether it's with you know, stressful situations with a patient, good or bad outcome, you do feel I always felt kind of closer to the people in the room, and so do you feel like you've made some good friendships with the surgeons over the years. No not really.
Speaker 2:Generally the surgeons kind of do. They're kind of their own entity. You know what?
Speaker 1:They're not very touchy-feely by nature. They're kind of more rigid and as an oncologist, even though I'm in the OR, maybe my job's a little bit more, maybe attracts people who are a little bit more, have more emotion and stuff like that, and so that could just be a one-off of me feeling that close. But, like you, I always love seeing you and we always talk about football and it's. I think that's one of the best things about being a doctor here at St Luke's is that you end up having a lot of friends and people that you, you know, you've had a longitudinal relationship with.
Speaker 2:And there's a lot and it also goes with personalities. A lot of you're at work, it is work, and we have a schedule we have to get done and we have add-ons and we have other things that come up, and so the surgeon seems really really focused on the schedule and such. And you know, and if it gets into kind of a longer case, then there might be a little bit of you know chit chat, but there's usually not a lot and it's also just different personalities. Yeah, you know, some people are more open to having a conversation than others and generally I am, you know, and a lot of people don't probably realize, being the anesthesia. It's just like in the movies where you have a screen so you don't even see me. I'm behind this, like you know this paper wall, yeah, and so you don't, even when you look for me, you don't see me. Yeah, you just see this paper wall. Okay, got you. So you know, that's kind of. Also you're talking to a drape.
Speaker 1:Yeah, gotcha, and in the cases we do together it's a lot more simpler, correct, like with you and the cases you do.
Speaker 2:There is no drape.
Speaker 1:Yeah, okay, gotcha.
Speaker 2:And those aren't very, those are not the usual, yeah.
Speaker 1:They're pretty quick in and out. And so now, with the advent of these ambulatory surgery centers these are surgery centers that are off-site from a hospital and there's incentives by the payers to try to get patients to have now you have to staff the hospital with anesthesia providers but also these off-site facilities, and so it's in high demand. Is that right? Oh, absolutely. Do you know if they're opening up new schools or increasing the enrollments? I don't.
Speaker 2:You're far away from that. I got out of it. I ran. It was so challenging that once I got my foot out the door I just kept going. I do know that there are, because just here recently I found out that when I went there was not a single anesthesia school in the state of Mississippi, because we had students in my class that would come over and they got to have in-state tuition because they didn't have an opportunity in their state. And I know now that there's multiple. So I do know for a fact there is.
Speaker 1:Yeah, they probably expanded and I think there's this for a while. There's a shortage of workers in general and including health care workers, and we went and petitioned the state and I'm sure other people did at other states to increase the amount of nurses, so that you know the number of just nurses that are graduating every year from a state. That's actually mandated by the state government, and so those have been petitioned to try to increase the need, not only for the aging kind of baby boomer populations but for some of these other reasons.
Speaker 1:And so you know, if you're a young person out there looking at becoming a CRNA, I think if you look at the Bureau of Labor Statistics, the occupational outlook is excellent.
Speaker 2:Oh, it's wonderful, but at the same time, plan ahead. Yeah, you're talking nine years.
Speaker 1:Yeah, and you know, nursing, I think, has had these boom and bust cycles where they were really in need and then not so much in need and then really in need. My assumption is the demand is high right now just because a lot of people retired during COVID Right, and so these are also things that anesthesiologists and nurses are not going to be replaced by AI? No, I don't think no, and so if you're young, that's one thing to look into, you know cannot work from home.
Speaker 2:Yeah, yeah.
Speaker 1:Yeah, that's, that's. That's a downside but it's a good side, because you're probably not going to be replaced by a computer, can you? Are there any really interesting cases that you've had, whether it was on the anesthesia side or the surgical side, that you can recall or really stick in your mind?
Speaker 2:Just only ones that really stick in my head are the scary ones. I've been very fortunate. I have never lost a patient in all the years. You're kidding me Never.
Speaker 1:Wow, I would think that's. I mean, you've been doing this for a while. I would think that's fairly unique.
Speaker 2:It's. You know, I'm not saying it's because of me. I'm just saying I've been very fortunate.
Speaker 1:Yeah, sometimes you don't have to break your arm pat yourself on the back, but I mean, yeah, I mean it's a feather in your cap, for sure.
Speaker 2:And you know that's something that I don't want to break. I don't want to change that. You know I would like to retire saying that same thing. But not everybody can say that, you know. But not everybody can say that you know and it's, and it's just. It's not so much like it's, like I say, it's not because you know I'm, you know the end, all be all, it's just because I honestly feel like it just wasn't, it wasn't their time.
Speaker 1:Yeah.
Speaker 2:And if it's not their time, it's not their time Because I mean I've had patients that I could not believe yeah, didn't, and they and they didn't. They pull through, yes, yeah, and I mean you're talking a whole room full of anesthesia workers in there trying to keep this patient alive and did so, yeah yeah, that's one of the shocking things.
Speaker 1:I mean you know the amount of you know what, what a mess uh, whether it's a, a code or or an or room can be, especially with the trauma. Somebody gets in and you're getting them very quick and just the chaos of it.
Speaker 2:The blood the amount of blood that a human can lose yeah, and the amount of blood you can pump into a human, the amount of things you can put down their throat, the amount of things that you can do to this person yeah.
Speaker 1:You can empty the blood bank, oh, yeah, and so yeah, I think my wife got in trouble maybe a couple of years ago from emptying the blood bank of something. Maybe it was fresh frozen plasma or something like that, but I mean, you know it was a. I won't get into the details, but it was a. You know you can really pump a lot of blood products. Oh, absolutely, you know whether it's fresh frozen plasma or packed red blood cells, and I'm sure you do plenty of times and you know, especially in the level in Toronto Center we did yeah, we had.
Speaker 2:You know it's one of those where it was kind of the joke. You know you're hanging and dropping bags on the floor and after it's over you count the bags. I mean, you have no idea, you've just been pushing, you've had. You know, I've had pressure bags going, both hands squeezing as hard as I can squeeze you know just rocking and rolling and trying to outpace what's being lost, and it's just you know it's.
Speaker 1:And young people, I mean, are certainly more resilient. You know, when you're young you're able to get through some really tough stuff, you know, whereas older people wouldn't, and so that's the crazy cases I've seen is, you know, youngsters where there's 12-year year old or something like that, and kind of get through something that's just totally crazy, that that there's no way even a 20 year old could get through it. Um, and so those, those are the ones that stick in your mind. Yeah, um the um, and so burnout is something that I, honestly, I kind of feel two ways about it. Burnout is something that I, honestly, I kind of feel two ways about it.
Speaker 1:It's kind of a big conversation in healthcare, but I also think that, like there's a lot of tough jobs out there and so and I feel like it probably gets talked about in healthcare more than other places, and I I don't ever want it to seem like I think healthcare is like the toughest job out there. I always want to have respect for everybody that's working, because everybody has a lot of, you know, stress in their life and in their professional jobs. But it's been a big thing, you know, in 2024 and 2025. Do you see that in your colleagues, or do you feel that in yourself? I do I do.
Speaker 2:It's a. It's a very stressful job. What I, what we do yeah. Whether it's a very stressful job, what we do yeah. Whether it's you know my job, your job, your job is a little. I see your job as more of a it's a different type. Kind of sad. You know it's a lot of sadness.
Speaker 1:But a lot of it's a lot of lows and a lot of highs, right Well, yeah, yeah and so.
Speaker 2:And on my side it's just a lot of, you know, it's a lot of angst. You know cause. You know, every we're watching, we're watching the patient's heartbeat and breathing, and every second by second, by second, by second. You know, and so you know, everything we do has to be fast, everything has to be, you know, uh, you know, if you have to immediately find it and fix it and carry on.
Speaker 1:So um, do you feel like you've adapted to that to some degree over time? I mean, I'm sure in the OR you're more relaxed now than you were the first year out.
Speaker 2:In fact, I would say you, almost after doing it this long, you can kind of tell when it's coming. Okay, not always, but you definitely start seeing a trend in your life, kind of a sense no more of a trend, no more of a trend. You'll start seeing kind of a trend in their kind of how their, just how all their vitals are going Gotcha, and so you can head it off, yeah, if you can kind of catch it. Yeah, but you've got to be pretty vigilant though, and it's just been doing it for so many years that you'll see it's like I'm not real hot on this. Let me kind of I'm going to fix this. The hair on the back of your neck kind of stands up. I'm going to go ahead and fix this, yeah, because we can control everything.
Speaker 1:Yeah, heart rate, blood pressure, breathing, you know yeah. Yeah, I do agree with you on that one. It almost sounds like it's some je ne sais quoi, it's a feeling. But that one it almost sounds like it's some some je ne sais quoi, it's a feeling. But you do get that about sometimes. I mean, you know, sometimes plenty of patients I've seen they kind of report just very mild issues with breathing and they say I'm probably okay, but maybe it's something they said or something in the circumstance and you're like you know what? We should probably send you for a ct pulmonary embolism protocol and you a scan and the symptoms were not really that remarkable. And then you catch one and then it looks like you're the Michael Jordan.
Speaker 1:And it's not brilliance, it's more just reputation.
Speaker 2:Absolutely Just years of doing this and seeing that little dot run across the screen millions and millions and millions of times. And you see one and sometimes it just doesn't look quite right and that usually means it's not.
Speaker 1:So trust that instinct, right yeah.
Speaker 2:And I've been wrong just as many or more times too, thinking this, you know, or before I say you know, I meet and greet the patient, I read their history and I see, you know, I read everything about the patient. I'm thinking, you know? You know, this is probably going to be a little challenging, and they fly right through it like a 20-year-old runner. You know, and I'm like, wow, I wouldn't have thought that that was pretty awesome. You know, yeah, and then you get the 20 year old runner and you're like what are you doing? You know, you're supposed to be a 20 year old runner. You're not acting like that. You know, you're acting like the 80 year old. That, you know, needs needs to be tuned up a little bit better.
Speaker 1:Yeah yeah, the favorite runs the horse race. A lot of the times, but not always, you get a hairy and everything. Well, jared, I always enjoy working with you Pleasure and it really is a pleasure when I see you in the OR, because I usually don't know who's covering the case until I walk in and see you. But I appreciate the time we spent in the OR and I appreciate you coming on today.
Speaker 2:Well, thank you for having me, and it's always a pleasure working with you. Thanks, buddy, thank you.