April 2, 2025 • 24 mins
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.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hello, this is Jason Edwards and this is Doc
Discussions.
I'm joined today by JaredBarton.
Jared is a CRNA Jared.
How are you doing today?
Speaker 2 (00:08):
I'm doing good.
Thank you for having me.
Speaker 1 (00:09):
You bet buddy.
And now?
What is a CRNA?
Can you explain that to people?
Speaker 2 (00:14):
Sure, it is the nurse equivalent of an
anesthesiologist.
In fact, one of our names thatwe go by is a nurse
anesthesiologist.
We One of our names that we goby is a nurse anesthesiologist.
We do the exact same things.
We can do everything that theycan do, except for writing
scripts, obviously, but we doanesthesia of all different
types.
Whatever is needed, we can do.
(00:34):
Some states are actuallywithout anesthesiologists, so
the hospitals are completelyvoid of any anesthesiologists,
only CRNAs.
Speaker 1 (00:45):
And rural hospitals sometimes will just have a CRNA.
Is that right?
Yes, Mm-hmm.
Speaker 2 (00:49):
Yeah, and, like I said, certain states are what we
call, in the industry, freestates.
Speaker 1 (00:54):
Okay, sure.
Speaker 2 (00:57):
There's no requirement for a doctor Within
the hospital like at St Luke's.
Here, where I am, you know, Ihave free run of.
I can order any drug, prettymuch I want, but I have to order
it under a medical doctor.
Got you.
Speaker 1 (01:12):
Yeah, and so it's.
Speaker 2 (01:13):
It's to me, from the outside, looking in, it's a
little bit odd, because it seemslike 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 whatbetween the anesthesiologist and
the CRNAs, but they also workwith each other and are friends,
and what you'll find is likewhere I trained in Alabama, all
(01:38):
of your residents are trained bythe CRNAs, so your older
anesthesiologistologists itwasn't that way, and so there is
a big divide because they stillreally want to hold on to every
bit of you know more power thatthey have over us, whereas the
younger generation I see that'scoming up being trained by the
(02:01):
crnas have a lot of respect forthe crnas.
Yeah, we, we study the samebooks.
We say we have to take nationalboards just like they do.
It's.
You know, we do blocks, we cando you know anything.
Anything they can do other thanwe.
Speaker 1 (02:13):
We don't have the power of the pen when it comes
to scribs yeah, and crnas havebeen around for a long time um
somebody was telling me that the, the training regimen, actually
had kind of a military originand I don't know the whole
origin story of it, but I knowit's a very regimented training
program.
Speaker 2 (02:36):
It is and, in fact, your nurse care.
They weren't nurses like that,obviously, but nursing for
anesthesia came first beforemedical doctors of anesthesia
got you.
So, um, you know that wouldtell whatever that means.
Yeah, you know, the I never.
I never find really that thethere's a lot of and again, I
find that it's it's wherever,it's where you go, because
(02:59):
there's a lot of.
Uh, most places where you go inin the settings, the doctors
are supervising, okay, theydon't actually do any anesthesia
, yeah, whereas the CRNAs do allof your anesthesia.
And if you're a patient, a lotof people don't recognize this,
but I would say I believe thelast time I saw it was 80% or
(03:21):
better of all anesthetics areprovided by a nurse anesthetist.
Speaker 1 (03:24):
How about that?
Speaker 2 (03:25):
Yeah, 80% or better of all anesthetics are provided
by a nurse anesthetist.
How about that?
So the likelihood of you havinga surgery and having what you
thought was an anesthesiologistis probably not an
anesthesiologist.
You may have met him and hemight have asked you questions,
and then, when you got to theroom, it was a CRNA doing your
procedure.
Yeah, and that's very common.
Speaker 1 (03:40):
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 youpersonally.
So what has been your kind ofmedical history up to this point
, as far as where you firststarted working or where you
(04:02):
went to school first?
Speaker 2 (04:03):
So I went to the University of Alabama at
Birmingham, which is UAB.
It's a huge medical facility indowntown Birmingham.
It's the Southeast TraumaCenter, so they have their own
jet airplane service, wow, andso it's huge.
I mean, when you say big's big,it's gigantic, big um, well,
(04:28):
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.
It is something where you spenda lot of your time the night
before reading because it's likewhat is this procedure?
I have no idea, because they doso many one-offs, yeah, so many
(04:49):
rare procedures you won't seeanywhere else.
But the school that I went towas very militant, like you said
, very strict.
I mean nothing like what I'veseen.
I've been there, I've been inKansas and I've been here in
Missouri and just seeing thekind of what is allowed from the
(05:10):
students or what is acceptedfrom the students is quite
different from what it was, andit may be also a difference in
time.
This is quite a while back,yeah, different eras.
When I was coming through,nothing was accepted other than
the you know, the best of thebest pretty rigid very yeah, um
which which most people uh, it'slike not fun to go through, but
(05:32):
most people find effective,very effective, yeah, very
effective um, in fact, I believethat's what really gave me a
leg up on a lot of other placesis because you'd be so well
known and I think they are sowell known because you do have
that kind of fear factor,because they don't mess around.
If you are kicked out of a roomfor any reason, you are out of
(05:55):
the program.
Okay, so you're done.
One strike.
Speaker 1 (05:58):
Yeah, are you from that area?
Yes, and do you know a guynamed Gene Bartow?
Yes, so he was the basketballcoach 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 KevinBartow.
Speaker 2 (06:13):
Oh, did not know that .
Speaker 1 (06:14):
But I went to high school with him, yeah, and so,
and actually him and Dr Bostonwere, I think, co-residents
together.
The basketball arena is theGene Bartow.
Is that right?
Okay, yeah, and then and then.
So after nursing school, didyou work as a nurse or did you
go straight into CRNA?
Speaker 2 (06:30):
school.
No, you can't, you have to putin your time.
So there is a requirement fortwo year minimum.
And it has to be ICU and it hasto be certain ICUs, okay, and
so not just any ICU like NICU,your neuro, nor your infants,
gotcha.
It's an adult ICU, correct?
(06:52):
And it can't be.
You know, I was on the SICUsurgical side, where there's a
medical MICU and they generallydon't take people from that side
either.
They's a medical MICU and theydon't.
They generally don't takepeople from that side either.
They won't, they won't.
Cic it was cardiac, gotcha,they big on that but that and
(07:13):
surgical, because obviously whatwe do is surgery, but um,
that's generally the two pullsthat they they want to draw from
and so you did a couple yearsof that and then went to.
Speaker 1 (07:22):
I did.
Speaker 2 (07:23):
I did exactly two years almost to the day.
And not that there was anythingwrong with it, I was just.
I worked in the ICU in a verychallenging hospital in the west
side of Birmingham, which isthe most dangerous side of
Birmingham, so we got a lot ofgunshots, a lot of trauma, lots
of trauma, yeah.
And so I think that, plus, Iwas a little bit older getting
(07:45):
into this, so I wasn't young,but I wasn't old.
But at the same time, they lookat that too, because you're
more mature.
Speaker 1 (07:53):
Yeah, and, and you know the ICU, oftentimes you
have younger nurses there justbecause 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 tochase that tends to fade a
little bit.
Speaker 2 (08:14):
My first job out of anesthesia school was a level
one trauma center, so you know Icut my teeth on that pretty
hard.
Speaker 1 (08:23):
Which is great, oh yeah.
Speaker 2 (08:25):
I mean, I learned.
I learned like you wouldn'tbelieve the stuff that I learned
, seeing some of the stuff I'llnever 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 tothat.
Speaker 1 (08:36):
And you know, for better or worse you get
desensitized to some of thesereally crazy situations.
You know somebody comes in withany kind of trauma.
You know you can have horribletraumas with a car wreck, a dog,
bullets, knives and, and it'sgood, in a sense, to become
somewhat desensitized to that.
So you kind of have a cool headand that's a good way to kind
(08:57):
of start your training off.
So, cause, cause, it's probablynot very often, but every once
in a while I'm sure things comeup at work that are kind of, uh,
you know, gets the heart racinga little bit.
Oh yeah, absolutely.
Having that experience, youknow, helps you keep a steady
hand to the till.
Speaker 2 (09:12):
There was always the thing that was always really
hammered to us in school, andthat was always always
everything's okay and so onlywhen it's not okay is when you
call for help.
Speaker 1 (09:24):
Yeah.
Speaker 2 (09:24):
And so that meaning is that the doctors really never
know what's happening.
They're focused on what they doand they're trying to get in
and get what they are going forthe surgeon.
Speaker 1 (09:36):
And get out.
Speaker 2 (09:36):
Yes, yeah, and then our yes, yeah, and then our job
is basically make it so that thepatient lives through this
procedure.
And so when you start seeingthings such as you know, you see
blood pressures that aren'tthat great or heart rates that
are getting a little weak, youget blood pressures that are
real soft, that type of thingyou know that they're bleeding.
(09:57):
You can hear it.
There's all these.
You know you're reallymaximizing all of your sensory
yeah and and everything you can.
You can do so much, and sothat's when and a lot of the, a
lot of the surgeons they'll theycan tell, because they'll start
hearing a lot of work happeningbehind that screen and you can
hear the beeping.
Speaker 1 (10:16):
you know you can hear like we can all hear the
beeping of the heart rate, andso you know if things are
changing.
Speaker 2 (10:20):
But I know, even like if I'm, if I'm just getting set
up and kind of ready for mynext case or whatever, a lot of
times they'll sort of be likeJared, 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 goingto make it where it doesn't
matter.
So you do keep doing what youneed to do.
Speaker 1 (10:40):
They can focus on what they're doing, right, yeah?
Speaker 2 (10:41):
And that's what that's.
My job is to help the surgeonas much as it is to help the
patient.
Speaker 1 (10:46):
You know the I part of my training was in general
surgery and you, when you gothrough tough situations with
people, I feel like you reallydo 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 theroom, and so do you feel like
(11:09):
you've made some goodfriendships with the surgeons
over the years.
No not really.
Speaker 2 (11:15):
Generally the surgeons kind of do.
They're kind of their ownentity.
You know what?
Speaker 1 (11:20):
They're not very touchy-feely by nature.
They're kind of more rigid andas an oncologist, even though
I'm in the OR, maybe my job's alittle bit more, maybe attracts
people who are a little bit more, have more emotion and stuff
like that, and so that couldjust be a one-off of me feeling
that close.
But, like you, I always loveseeing you and we always talk
(11:43):
about football and it's.
I think that's one of the bestthings about being a doctor here
at St Luke's is that you end uphaving a lot of friends and
people that you, you know,you've had a longitudinal
relationship with.
Speaker 2 (11:53):
And there's a lot and it also goes with personalities
.
A lot of you're at work, it iswork, and we have a schedule we
have to get done and we haveadd-ons and we have other things
that come up, and so thesurgeon seems really really
focused on the schedule and such.
(12:17):
And you know, and if it getsinto kind of a longer case, then
there might be a little bit ofyou know chit chat, but there's
usually not a lot and it's alsojust different personalities.
Yeah, you know, some people aremore open to having a
conversation than others andgenerally I am, you know, and a
(12:37):
lot of people don't probablyrealize, being the anesthesia.
It's just like in the movieswhere you have a screen so you
don't even see me.
I'm behind this, like you knowthis paper wall, yeah, and so
you don't, even when you lookfor me, you don't see me.
Yeah, you just see this paperwall.
Okay, got you.
So you know, that's kind of.
Also you're talking to a drape.
Speaker 1 (12:56):
Yeah, gotcha, and in the cases we do together it's a
lot more simpler, correct, likewith you and the cases you do.
Speaker 2 (13:03):
There is no drape.
Speaker 1 (13:04):
Yeah, okay, gotcha.
Speaker 2 (13:05):
And those aren't very , those are not the usual, yeah.
Speaker 1 (13:26):
They're pretty quick in and out.
And so now, with the advent ofthese ambulatory surgery centers
these are surgery centers thatare off-site from a hospital and
there's incentives by thepayers to try to get patients to
have now you have to staff thehospital with anesthesia
providers but also theseoff-site facilities, and so it's
in high demand.
Is that right?
Oh, absolutely.
(13:47):
Do you know if they're openingup new schools or increasing the
enrollments?
I don't.
Speaker 2 (13:51):
You're far away from that.
I got out of it.
I ran.
It was so challenging that onceI 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 therewas not a single anesthesia
(14:12):
school in the state ofMississippi, because we had
students in my class that wouldcome over and they got to have
in-state tuition because theydidn't have an opportunity in
their state.
And I know now that there'smultiple.
So I do know for a fact thereis.
Speaker 1 (14:26):
Yeah, they probably expanded and I think there's
this for a while.
There's a shortage of workersin general and including health
care workers, and we went andpetitioned the state and I'm
sure other people did at otherstates to increase the amount of
nurses, so that you know thenumber of just nurses that are
graduating every year from astate.
(14:46):
That's actually mandated by thestate government, and so those
have been petitioned to try toincrease the need, not only for
the aging kind of baby boomerpopulations but for some of
these other reasons.
And so you know, if you're ayoung person out there looking
at becoming a CRNA, I think ifyou look at the Bureau of Labor
Statistics, the occupationaloutlook is excellent.
Speaker 2 (15:05):
Oh, it's wonderful, but at the same time, plan ahead
.
Yeah, you're talking nine years.
Speaker 1 (15:10):
Yeah, and you know, nursing, I think, has had these
boom and bust cycles where theywere really in need and then not
so much in need and then reallyin need.
My assumption is the demand ishigh right now just because a
lot of people retired duringCOVID Right, and so these are
also things thatanesthesiologists and nurses are
(15:32):
not going to be replaced by AI?
No, I don't think no, and so ifyou're young, that's one thing
to look into, you know cannotwork from home.
Speaker 2 (15:41):
Yeah, yeah.
Speaker 1 (15:42):
Yeah, that's, that's.
That's a downside but it's agood side, because you're
probably not going to bereplaced by a computer, can you?
Are there any reallyinteresting cases that you've
had, whether it was on theanesthesia side or the surgical
side, that you can recall orreally stick in your mind?
Speaker 2 (16:00):
Just only ones that really stick in my head are the
scary ones.
I've been very fortunate.
I have never lost a patient inall the years.
You're kidding me Never.
Speaker 1 (16:11):
Wow, I would think that's.
I mean, you've been doing thisfor a while.
I would think that's fairlyunique.
Speaker 2 (16:17):
It's.
You know, I'm not saying it'sbecause of me.
I'm just saying I've been veryfortunate.
Speaker 1 (16:23):
Yeah, sometimes you don't have to break your arm pat
yourself on the back, but Imean, yeah, I mean it's a
feather in your cap, for sure.
Speaker 2 (16:32):
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 retiresaying that same thing.
But not everybody can say that,you know.
But not everybody can say thatyou 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, allbe all, it's just because I
honestly feel like it justwasn't, it wasn't their time.
Speaker 1 (16:55):
Yeah.
Speaker 2 (16:56):
And if it's not their time, it's not their time
Because I mean I've had patientsthat 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 anesthesiaworkers in there trying to keep
this patient alive and did so,yeah yeah, that's one of the
shocking things.
Speaker 1 (17:14):
I mean you know the amount of you know what, what a
mess uh, whether it's a, a codeor or an or room can be,
especially with the trauma.
Somebody gets in and you'regetting them very quick and just
the chaos of it.
Speaker 2 (17:28):
The blood the amount of blood that a human can lose
yeah, and the amount of bloodyou can pump into a human, the
amount of things you can putdown their throat, the amount of
things that you can do to thisperson yeah.
Speaker 1 (17:38):
You can empty the blood bank, oh, yeah, and so
yeah, I think my wife got introuble maybe a couple of years
ago from emptying the blood bankof something.
Maybe it was fresh frozenplasma 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 alot of blood products.
Oh, absolutely, you knowwhether it's fresh frozen plasma
or packed red blood cells, andI'm sure you do plenty of times
(18:01):
and you know, especially in thelevel in Toronto Center we did
yeah, we had.
Speaker 2 (18:06):
You know it's one of those where it was kind of the
joke.
You know you're hanging anddropping bags on the floor and
after it's over you count thebags.
I mean, you have no idea,you've just been pushing, you've
had.
You know, I've had pressurebags going, both hands squeezing
as hard as I can squeeze youknow just rocking and rolling
and trying to outpace what'sbeing lost, and it's just you
(18:28):
know it's.
Speaker 1 (18:30):
And young people, I mean, are certainly more
resilient.
You know, when you're youngyou're able to get through some
really tough stuff, you know,whereas older people wouldn't,
and so that's the crazy casesI've seen is, you know,
youngsters where there's 12-yearyear old or something like that
, and kind of get throughsomething that's just totally
crazy, that that there's no wayeven a 20 year old could get
through it.
Um, and so those, those are theones that stick in your mind.
(18:52):
Yeah, um the um, and so burnoutis 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.
It's kind of a big conversationin healthcare, but I also think
that, like there's a lot oftough jobs out there and so and
I feel like it probably getstalked about in healthcare more
(19:14):
than other places, and I I don'tever want it to seem like I
think healthcare is like thetoughest job out there.
I always want to have respectfor 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, youknow, in 2024 and 2025.
Do you see that in yourcolleagues, or do you feel that
(19:36):
in yourself?
I do I do.
Speaker 2 (19:38):
It's a.
It's a very stressful job.
What I, what we do yeah.
Whether it's a very stressfuljob, 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 ait's a different type.
Kind of sad.
You know it's a lot of sadness.
Speaker 1 (19:52):
But a lot of it's a lot of lows and a lot of highs,
right Well, yeah, yeah and so.
Speaker 2 (19:57):
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, andevery 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 itand carry on.
Speaker 1 (20:18):
So um, do you feel like you've adapted to that to
some degree over time?
I mean, I'm sure in the ORyou're more relaxed now than you
were the first year out.
Speaker 2 (20:27):
In fact, I would say you, almost after doing it this
long, you can kind of tell whenit's coming.
Okay, not always, but youdefinitely start seeing a trend
in your life, kind of a sense nomore of a trend, no more of a
trend.
You'll start seeing kind of atrend in their kind of how their
, just how all their vitals aregoing Gotcha, and so you can
(20:51):
head it off, yeah, if you cankind of catch it.
Yeah, but you've got to bepretty vigilant though, and it's
just been doing it for so manyyears that you'll see it's like
I'm not real hot on this.
Let me kind of I'm going to fixthis.
The hair on the back of yourneck kind of stands up.
I'm going to go ahead and fixthis, yeah, because we can
control everything.
Speaker 1 (21:11):
Yeah, heart rate, blood pressure, breathing, you
know yeah.
Yeah, I do agree with you onthat one.
It almost sounds like it's someje ne sais quoi, it's a feeling
.
But that one it almost soundslike it's some some je ne sais
quoi, it's a feeling.
But you do get that aboutsometimes.
I mean, you know, sometimesplenty of patients I've seen
they kind of report just verymild issues with breathing and
(21:31):
they say I'm probably okay, butmaybe it's something they said
or something in the circumstanceand you're like you know what?
We should probably send you fora ct pulmonary embolism
protocol and you a scan and thesymptoms were not really that
remarkable.
And then you catch one and thenit looks like you're the
(21:52):
Michael Jordan.
And it's not brilliance, it'smore just reputation.
Speaker 2 (21:58):
Absolutely Just years of doing this and seeing that
little dot run across the screenmillions and millions and
millions of times.
And you see one and sometimesit just doesn't look quite right
and that usually means it's not.
Speaker 1 (22:16):
So trust that instinct, right yeah.
Speaker 2 (22:18):
And I've been wrong just as many or more times too,
thinking this, you know, orbefore I say you know, I meet
and greet the patient, I readtheir history and I see, you
know, I read everything aboutthe patient.
I'm thinking, you know?
You know, this is probablygoing to be a little challenging
, and they fly right through itlike a 20-year-old runner.
You know, and I'm like, wow, Iwouldn't have thought that that
(22:38):
was pretty awesome.
You know, yeah, and then youget the 20 year old runner and
you're like what are you doing?
You know, you're supposed to bea 20 year old runner.
You're not acting like that.
You know, you're acting likethe 80 year old.
That, you know, needs needs tobe tuned up a little bit better.
Speaker 1 (22:51):
Yeah yeah, the favorite runs the horse race.
A lot of the times, but notalways, you get a hairy and
everything.
Well, jared, I always enjoyworking with you Pleasure and it
really is a pleasure when I seeyou in the OR, because I
usually don't know who'scovering the case until I walk
in and see you.
But I appreciate the time wespent in the OR and I appreciate
(23:12):
you coming on today.
Speaker 2 (23:12):
Well, thank you for having me, and it's always a
pleasure working with you.
Thanks, buddy, thank you.
Hello, this is Jason Edwards and this is Doc
Discussions.
I'm joined today by JaredBarton.
Jared is a CRNA Jared.
How are you doing today?
Speaker 2 (00:08):
I'm doing good.
Thank you for having me.
Speaker 1 (00:09):
You bet buddy.
And now?
What is a CRNA?
Can you explain that to people?
Speaker 2 (00:14):
Sure, it is the nurse equivalent of an
anesthesiologist.
In fact, one of our names thatwe go by is a nurse
anesthesiologist.
We One of our names that we goby is a nurse anesthesiologist.
We do the exact same things.
We can do everything that theycan do, except for writing
scripts, obviously, but we doanesthesia of all different
types.
Whatever is needed, we can do.
(00:34):
Some states are actuallywithout anesthesiologists, so
the hospitals are completelyvoid of any anesthesiologists,
only CRNAs.
Speaker 1 (00:45):
And rural hospitals sometimes will just have a CRNA.
Is that right?
Yes, Mm-hmm.
Speaker 2 (00:49):
Yeah, and, like I said, certain states are what we
call, in the industry, freestates.
Speaker 1 (00:54):
Okay, sure.
Speaker 2 (00:57):
There's no requirement for a doctor Within
the hospital like at St Luke's.
Here, where I am, you know, Ihave free run of.
I can order any drug, prettymuch I want, but I have to order
it under a medical doctor.
Got you.
Speaker 1 (01:12):
Yeah, and so it's.
Speaker 2 (01:13):
It's to me, from the outside, looking in, it's a
little bit odd, because it seemslike 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 whatbetween the anesthesiologist and
the CRNAs, but they also workwith each other and are friends,
and what you'll find is likewhere I trained in Alabama, all
(01:38):
of your residents are trained bythe CRNAs, so your older
anesthesiologistologists itwasn't that way, and so there is
a big divide because they stillreally want to hold on to every
bit of you know more power thatthey have over us, whereas the
younger generation I see that'scoming up being trained by the
(02:01):
crnas have a lot of respect forthe crnas.
Yeah, we, we study the samebooks.
We say we have to take nationalboards just like they do.
It's.
You know, we do blocks, we cando you know anything.
Anything they can do other thanwe.
Speaker 1 (02:13):
We don't have the power of the pen when it comes
to scribs yeah, and crnas havebeen around for a long time um
somebody was telling me that the, the training regimen, actually
had kind of a military originand I don't know the whole
origin story of it, but I knowit's a very regimented training
program.
Speaker 2 (02:36):
It is and, in fact, your nurse care.
They weren't nurses like that,obviously, but nursing for
anesthesia came first beforemedical doctors of anesthesia
got you.
So, um, you know that wouldtell whatever that means.
Yeah, you know, the I never.
I never find really that thethere's a lot of and again, I
find that it's it's wherever,it's where you go, because
(02:59):
there's a lot of.
Uh, most places where you go inin the settings, the doctors
are supervising, okay, theydon't actually do any anesthesia
, yeah, whereas the CRNAs do allof your anesthesia.
And if you're a patient, a lotof people don't recognize this,
but I would say I believe thelast time I saw it was 80% or
(03:21):
better of all anesthetics areprovided by a nurse anesthetist.
Speaker 1 (03:24):
How about that?
Speaker 2 (03:25):
Yeah, 80% or better of all anesthetics are provided
by a nurse anesthetist.
How about that?
So the likelihood of you havinga surgery and having what you
thought was an anesthesiologistis probably not an
anesthesiologist.
You may have met him and hemight have asked you questions,
and then, when you got to theroom, it was a CRNA doing your
procedure.
Yeah, and that's very common.
Speaker 1 (03:40):
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 youpersonally.
So what has been your kind ofmedical history up to this point
, as far as where you firststarted working or where you
(04:02):
went to school first?
Speaker 2 (04:03):
So I went to the University of Alabama at
Birmingham, which is UAB.
It's a huge medical facility indowntown Birmingham.
It's the Southeast TraumaCenter, so they have their own
jet airplane service, wow, andso it's huge.
I mean, when you say big's big,it's gigantic, big um, well,
(04:28):
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.
It is something where you spenda lot of your time the night
before reading because it's likewhat is this procedure?
I have no idea, because they doso many one-offs, yeah, so many
(04:49):
rare procedures you won't seeanywhere else.
But the school that I went towas very militant, like you said
, very strict.
I mean nothing like what I'veseen.
I've been there, I've been inKansas and I've been here in
Missouri and just seeing thekind of what is allowed from the
(05:10):
students or what is acceptedfrom the students is quite
different from what it was, andit may be also a difference in
time.
This is quite a while back,yeah, different eras.
When I was coming through,nothing was accepted other than
the you know, the best of thebest pretty rigid very yeah, um
which which most people uh, it'slike not fun to go through, but
(05:32):
most people find effective,very effective, yeah, very
effective um, in fact, I believethat's what really gave me a
leg up on a lot of other placesis because you'd be so well
known and I think they are sowell known because you do have
that kind of fear factor,because they don't mess around.
If you are kicked out of a roomfor any reason, you are out of
(05:55):
the program.
Okay, so you're done.
One strike.
Speaker 1 (05:58):
Yeah, are you from that area?
Yes, and do you know a guynamed Gene Bartow?
Yes, so he was the basketballcoach 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 KevinBartow.
Speaker 2 (06:13):
Oh, did not know that .
Speaker 1 (06:14):
But I went to high school with him, yeah, and so,
and actually him and Dr Bostonwere, I think, co-residents
together.
The basketball arena is theGene Bartow.
Is that right?
Okay, yeah, and then and then.
So after nursing school, didyou work as a nurse or did you
go straight into CRNA?
Speaker 2 (06:30):
school.
No, you can't, you have to putin your time.
So there is a requirement fortwo year minimum.
And it has to be ICU and it hasto be certain ICUs, okay, and
so not just any ICU like NICU,your neuro, nor your infants,
gotcha.
It's an adult ICU, correct?
(06:52):
And it can't be.
You know, I was on the SICUsurgical side, where there's a
medical MICU and they generallydon't take people from that side
either.
They's a medical MICU and theydon't.
They generally don't takepeople from that side either.
They won't, they won't.
Cic it was cardiac, gotcha,they big on that but that and
(07:13):
surgical, because obviously whatwe do is surgery, but um,
that's generally the two pullsthat they they want to draw from
and so you did a couple yearsof that and then went to.
Speaker 1 (07:22):
I did.
Speaker 2 (07:23):
I did exactly two years almost to the day.
And not that there was anythingwrong with it, I was just.
I worked in the ICU in a verychallenging hospital in the west
side of Birmingham, which isthe most dangerous side of
Birmingham, so we got a lot ofgunshots, a lot of trauma, lots
of trauma, yeah.
And so I think that, plus, Iwas a little bit older getting
(07:45):
into this, so I wasn't young,but I wasn't old.
But at the same time, they lookat that too, because you're
more mature.
Speaker 1 (07:53):
Yeah, and, and you know the ICU, oftentimes you
have younger nurses there justbecause 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 tochase that tends to fade a
little bit.
Speaker 2 (08:14):
My first job out of anesthesia school was a level
one trauma center, so you know Icut my teeth on that pretty
hard.
Speaker 1 (08:23):
Which is great, oh yeah.
Speaker 2 (08:25):
I mean, I learned.
I learned like you wouldn'tbelieve the stuff that I learned
, seeing some of the stuff I'llnever 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 tothat.
Speaker 1 (08:36):
And you know, for better or worse you get
desensitized to some of thesereally crazy situations.
You know somebody comes in withany kind of trauma.
You know you can have horribletraumas with a car wreck, a dog,
bullets, knives and, and it'sgood, in a sense, to become
somewhat desensitized to that.
So you kind of have a cool headand that's a good way to kind
(08:57):
of start your training off.
So, cause, cause, it's probablynot very often, but every once
in a while I'm sure things comeup at work that are kind of, uh,
you know, gets the heart racinga little bit.
Oh yeah, absolutely.
Having that experience, youknow, helps you keep a steady
hand to the till.
Speaker 2 (09:12):
There was always the thing that was always really
hammered to us in school, andthat was always always
everything's okay and so onlywhen it's not okay is when you
call for help.
Speaker 1 (09:24):
Yeah.
Speaker 2 (09:24):
And so that meaning is that the doctors really never
know what's happening.
They're focused on what they doand they're trying to get in
and get what they are going forthe surgeon.
Speaker 1 (09:36):
And get out.
Speaker 2 (09:36):
Yes, yeah, and then our yes, yeah, and then our job
is basically make it so that thepatient lives through this
procedure.
And so when you start seeingthings such as you know, you see
blood pressures that aren'tthat great or heart rates that
are getting a little weak, youget blood pressures that are
real soft, that type of thingyou know that they're bleeding.
(09:57):
You can hear it.
There's all these.
You know you're reallymaximizing all of your sensory
yeah and and everything you can.
You can do so much, and sothat's when and a lot of the, a
lot of the surgeons they'll theycan tell, because they'll start
hearing a lot of work happeningbehind that screen and you can
hear the beeping.
Speaker 1 (10:16):
you know you can hear like we can all hear the
beeping of the heart rate, andso you know if things are
changing.
Speaker 2 (10:20):
But I know, even like if I'm, if I'm just getting set
up and kind of ready for mynext case or whatever, a lot of
times they'll sort of be likeJared, 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 goingto make it where it doesn't
matter.
So you do keep doing what youneed to do.
Speaker 1 (10:40):
They can focus on what they're doing, right, yeah?
Speaker 2 (10:41):
And that's what that's.
My job is to help the surgeonas much as it is to help the
patient.
Speaker 1 (10:46):
You know the I part of my training was in general
surgery and you, when you gothrough tough situations with
people, I feel like you reallydo 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 theroom, and so do you feel like
(11:09):
you've made some goodfriendships with the surgeons
over the years.
No not really.
Speaker 2 (11:15):
Generally the surgeons kind of do.
They're kind of their ownentity.
You know what?
Speaker 1 (11:20):
They're not very touchy-feely by nature.
They're kind of more rigid andas an oncologist, even though
I'm in the OR, maybe my job's alittle bit more, maybe attracts
people who are a little bit more, have more emotion and stuff
like that, and so that couldjust be a one-off of me feeling
that close.
But, like you, I always loveseeing you and we always talk
(11:43):
about football and it's.
I think that's one of the bestthings about being a doctor here
at St Luke's is that you end uphaving a lot of friends and
people that you, you know,you've had a longitudinal
relationship with.
Speaker 2 (11:53):
And there's a lot and it also goes with personalities
.
A lot of you're at work, it iswork, and we have a schedule we
have to get done and we haveadd-ons and we have other things
that come up, and so thesurgeon seems really really
focused on the schedule and such.
(12:17):
And you know, and if it getsinto kind of a longer case, then
there might be a little bit ofyou know chit chat, but there's
usually not a lot and it's alsojust different personalities.
Yeah, you know, some people aremore open to having a
conversation than others andgenerally I am, you know, and a
(12:37):
lot of people don't probablyrealize, being the anesthesia.
It's just like in the movieswhere you have a screen so you
don't even see me.
I'm behind this, like you knowthis paper wall, yeah, and so
you don't, even when you lookfor me, you don't see me.
Yeah, you just see this paperwall.
Okay, got you.
So you know, that's kind of.
Also you're talking to a drape.
Speaker 1 (12:56):
Yeah, gotcha, and in the cases we do together it's a
lot more simpler, correct, likewith you and the cases you do.
Speaker 2 (13:03):
There is no drape.
Speaker 1 (13:04):
Yeah, okay, gotcha.
Speaker 2 (13:05):
And those aren't very , those are not the usual, yeah.
Speaker 1 (13:26):
They're pretty quick in and out.
And so now, with the advent ofthese ambulatory surgery centers
these are surgery centers thatare off-site from a hospital and
there's incentives by thepayers to try to get patients to
have now you have to staff thehospital with anesthesia
providers but also theseoff-site facilities, and so it's
in high demand.
Is that right?
Oh, absolutely.
(13:47):
Do you know if they're openingup new schools or increasing the
enrollments?
I don't.
Speaker 2 (13:51):
You're far away from that.
I got out of it.
I ran.
It was so challenging that onceI 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 therewas not a single anesthesia
(14:12):
school in the state ofMississippi, because we had
students in my class that wouldcome over and they got to have
in-state tuition because theydidn't have an opportunity in
their state.
And I know now that there'smultiple.
So I do know for a fact thereis.
Speaker 1 (14:26):
Yeah, they probably expanded and I think there's
this for a while.
There's a shortage of workersin general and including health
care workers, and we went andpetitioned the state and I'm
sure other people did at otherstates to increase the amount of
nurses, so that you know thenumber of just nurses that are
graduating every year from astate.
(14:46):
That's actually mandated by thestate government, and so those
have been petitioned to try toincrease the need, not only for
the aging kind of baby boomerpopulations but for some of
these other reasons.
And so you know, if you're ayoung person out there looking
at becoming a CRNA, I think ifyou look at the Bureau of Labor
Statistics, the occupationaloutlook is excellent.
Speaker 2 (15:05):
Oh, it's wonderful, but at the same time, plan ahead
.
Yeah, you're talking nine years.
Speaker 1 (15:10):
Yeah, and you know, nursing, I think, has had these
boom and bust cycles where theywere really in need and then not
so much in need and then reallyin need.
My assumption is the demand ishigh right now just because a
lot of people retired duringCOVID Right, and so these are
also things thatanesthesiologists and nurses are
(15:32):
not going to be replaced by AI?
No, I don't think no, and so ifyou're young, that's one thing
to look into, you know cannotwork from home.
Speaker 2 (15:41):
Yeah, yeah.
Speaker 1 (15:42):
Yeah, that's, that's.
That's a downside but it's agood side, because you're
probably not going to bereplaced by a computer, can you?
Are there any reallyinteresting cases that you've
had, whether it was on theanesthesia side or the surgical
side, that you can recall orreally stick in your mind?
Speaker 2 (16:00):
Just only ones that really stick in my head are the
scary ones.
I've been very fortunate.
I have never lost a patient inall the years.
You're kidding me Never.
Speaker 1 (16:11):
Wow, I would think that's.
I mean, you've been doing thisfor a while.
I would think that's fairlyunique.
Speaker 2 (16:17):
It's.
You know, I'm not saying it'sbecause of me.
I'm just saying I've been veryfortunate.
Speaker 1 (16:23):
Yeah, sometimes you don't have to break your arm pat
yourself on the back, but Imean, yeah, I mean it's a
feather in your cap, for sure.
Speaker 2 (16:32):
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 retiresaying that same thing.
But not everybody can say that,you know.
But not everybody can say thatyou 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, allbe all, it's just because I
honestly feel like it justwasn't, it wasn't their time.
Speaker 1 (16:55):
Yeah.
Speaker 2 (16:56):
And if it's not their time, it's not their time
Because I mean I've had patientsthat 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 anesthesiaworkers in there trying to keep
this patient alive and did so,yeah yeah, that's one of the
shocking things.
Speaker 1 (17:14):
I mean you know the amount of you know what, what a
mess uh, whether it's a, a codeor or an or room can be,
especially with the trauma.
Somebody gets in and you'regetting them very quick and just
the chaos of it.
Speaker 2 (17:28):
The blood the amount of blood that a human can lose
yeah, and the amount of bloodyou can pump into a human, the
amount of things you can putdown their throat, the amount of
things that you can do to thisperson yeah.
Speaker 1 (17:38):
You can empty the blood bank, oh, yeah, and so
yeah, I think my wife got introuble maybe a couple of years
ago from emptying the blood bankof something.
Maybe it was fresh frozenplasma 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 alot of blood products.
Oh, absolutely, you knowwhether it's fresh frozen plasma
or packed red blood cells, andI'm sure you do plenty of times
(18:01):
and you know, especially in thelevel in Toronto Center we did
yeah, we had.
Speaker 2 (18:06):
You know it's one of those where it was kind of the
joke.
You know you're hanging anddropping bags on the floor and
after it's over you count thebags.
I mean, you have no idea,you've just been pushing, you've
had.
You know, I've had pressurebags going, both hands squeezing
as hard as I can squeeze youknow just rocking and rolling
and trying to outpace what'sbeing lost, and it's just you
(18:28):
know it's.
Speaker 1 (18:30):
And young people, I mean, are certainly more
resilient.
You know, when you're youngyou're able to get through some
really tough stuff, you know,whereas older people wouldn't,
and so that's the crazy casesI've seen is, you know,
youngsters where there's 12-yearyear old or something like that
, and kind of get throughsomething that's just totally
crazy, that that there's no wayeven a 20 year old could get
through it.
Um, and so those, those are theones that stick in your mind.
(18:52):
Yeah, um the um, and so burnoutis 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.
It's kind of a big conversationin healthcare, but I also think
that, like there's a lot oftough jobs out there and so and
I feel like it probably getstalked about in healthcare more
(19:14):
than other places, and I I don'tever want it to seem like I
think healthcare is like thetoughest job out there.
I always want to have respectfor 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, youknow, in 2024 and 2025.
Do you see that in yourcolleagues, or do you feel that
(19:36):
in yourself?
I do I do.
Speaker 2 (19:38):
It's a.
It's a very stressful job.
What I, what we do yeah.
Whether it's a very stressfuljob, 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 ait's a different type.
Kind of sad.
You know it's a lot of sadness.
Speaker 1 (19:52):
But a lot of it's a lot of lows and a lot of highs,
right Well, yeah, yeah and so.
Speaker 2 (19:57):
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, andevery 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 itand carry on.
Speaker 1 (20:18):
So um, do you feel like you've adapted to that to
some degree over time?
I mean, I'm sure in the ORyou're more relaxed now than you
were the first year out.
Speaker 2 (20:27):
In fact, I would say you, almost after doing it this
long, you can kind of tell whenit's coming.
Okay, not always, but youdefinitely start seeing a trend
in your life, kind of a sense nomore of a trend, no more of a
trend.
You'll start seeing kind of atrend in their kind of how their
, just how all their vitals aregoing Gotcha, and so you can
(20:51):
head it off, yeah, if you cankind of catch it.
Yeah, but you've got to bepretty vigilant though, and it's
just been doing it for so manyyears that you'll see it's like
I'm not real hot on this.
Let me kind of I'm going to fixthis.
The hair on the back of yourneck kind of stands up.
I'm going to go ahead and fixthis, yeah, because we can
control everything.
Speaker 1 (21:11):
Yeah, heart rate, blood pressure, breathing, you
know yeah.
Yeah, I do agree with you onthat one.
It almost sounds like it's someje ne sais quoi, it's a feeling
.
But that one it almost soundslike it's some some je ne sais
quoi, it's a feeling.
But you do get that aboutsometimes.
I mean, you know, sometimesplenty of patients I've seen
they kind of report just verymild issues with breathing and
(21:31):
they say I'm probably okay, butmaybe it's something they said
or something in the circumstanceand you're like you know what?
We should probably send you fora ct pulmonary embolism
protocol and you a scan and thesymptoms were not really that
remarkable.
And then you catch one and thenit looks like you're the
(21:52):
Michael Jordan.
And it's not brilliance, it'smore just reputation.
Speaker 2 (21:58):
Absolutely Just years of doing this and seeing that
little dot run across the screenmillions and millions and
millions of times.
And you see one and sometimesit just doesn't look quite right
and that usually means it's not.
Speaker 1 (22:16):
So trust that instinct, right yeah.
Speaker 2 (22:18):
And I've been wrong just as many or more times too,
thinking this, you know, orbefore I say you know, I meet
and greet the patient, I readtheir history and I see, you
know, I read everything aboutthe patient.
I'm thinking, you know?
You know, this is probablygoing to be a little challenging
, and they fly right through itlike a 20-year-old runner.
You know, and I'm like, wow, Iwouldn't have thought that that
(22:38):
was pretty awesome.
You know, yeah, and then youget the 20 year old runner and
you're like what are you doing?
You know, you're supposed to bea 20 year old runner.
You're not acting like that.
You know, you're acting likethe 80 year old.
That, you know, needs needs tobe tuned up a little bit better.
Speaker 1 (22:51):
Yeah yeah, the favorite runs the horse race.
A lot of the times, but notalways, you get a hairy and
everything.
Well, jared, I always enjoyworking with you Pleasure and it
really is a pleasure when I seeyou in the OR, because I
usually don't know who'scovering the case until I walk
in and see you.
But I appreciate the time wespent in the OR and I appreciate
(23:12):
you coming on today.
Speaker 2 (23:12):
Well, thank you for having me, and it's always a
pleasure working with you.
Thanks, buddy, thank you.
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