Cold table. Bright lights. Somebody asking you to count backward from ten. You get to about seven, and then nothing. You wake up later, foggy, and you can’t remember the name of the person who walked you into that room.

That person is the anesthesiologist, and most of us never get to talk to them.

I did, again, because Dr. Michael Huot came back on Doc Talk for his third visit. Back in February, he kept me safe through colorectal surgery to remove part of my colon. He walked in that morning, looked at me, and said he had my back. Seeing his face instead of a stranger’s settled something in me before they ever wheeled me in.

The Five Minutes Most People Never See

Anesthesia means more than sleep. Once the medication hits your IV, you’re out in ten or fifteen seconds, and the second you go under, you stop breathing. So Dr. Huot’s team takes over. They breathe for you, slide a tube into your trachea, hook you to a ventilator, and run the whole show.

Within five or ten minutes, he said, they have fully taken over all functions. “We can control your heart rate. We can control your blood pressure. We are breathing for you.”

He called it a little physiology lab. Give a bit of one medicine, the heart rate climbs. Give a bit of another, it drops. The goal is keeping you in one narrow plane the whole time. Not too light, not too deep.

For a procedure like mine, with a surgical robot involved, they inflate the abdomen to make room to work. That pushes up on your diaphragm, so they paralyze your muscles completely. “You couldn’t breathe on your own, even if you wanted to,” he said. Twenty years in, it still gets him. “It still amazes me that that’s what we do.”

Five Percent Terror, Ninety-Five Percent Boredom

The dangerous moments are going under and coming back up. “If you have a problem in the OR, you literally have minutes to fix it,” he said. “You have to know what to do immediately.”

At Monument Health they run a team model. Dr. Huot supervises four nurse anesthetists across multiple operating rooms. He’s there when you go to sleep, he checks in throughout, he’s there if there’s trouble, and he’s there at the end.

There’s a running joke about that ending. People always say, make sure you wake me up. “We actually get paid to wake you back up,” he said. “That’s where the money comes.”

Trauma Is the Hard Part

When I came in, they had my full history and planned for every pitfall. Trauma gives them none of that. Somebody gets in a wreck on Eighth Street, rolls into the ER unconscious, maybe down half their blood volume. “We don’t even know the patient’s blood type, and we’re rolling back to the room,” he said.

Monument’s team covers western South Dakota plus parts of Nebraska, Colorado, Wyoming, and North Dakota. People fly in by helicopter. “Our team saves people’s lives every single day,” he said. You’d never guess it driving around town.

I brought up malignant hyperthermia, partly because my wife and son both have it. Certain anesthetic agents can trigger a dangerous spike in body temperature. The fix is knowing ahead of time. “As long as we know, then there’s essentially no risk,” he said.

Anesthesia Got Quietly Very Safe

Before the 1980s, anesthesia wasn’t considered all that safe. So the specialty went all in on quality improvement, studying case reports and changing practices year over year. “There has been no specialty that has outperformed anesthesia in safety in the last forty years,” he said. For most people now, it’s safer than driving a car. Having seen the drivers around here, I’d call that one hundred percent accurate.

Where AI Is Headed in the OR

AI is already showing up in decision support. There’s a tool that takes a patient’s history and lays out the anesthetic considerations, and Dr. Huot has been testing it to see where it helps. “I think AI is going to play a major role in health care in the future,” he said.

He pointed to something that surprised him. “There’s a study that showed patients actually felt like AI was more empathetic to their problems than humans,” he said. The OR keeps a human at the center, with technology handling the heavy data work so the team can focus on the patient in front of them. Monument is part of the Mayo Clinic Care Network, which aims to roll out a thousand AI processes in the coming year.

Ask the Question

I asked what he wishes patients would bring up. “Whatever is on your mind, ask it,” he said. He had a young patient recently, clearly holding something back, so he sat down and chatted. Fifteen questions came tumbling out, and the fears came with them. The person left feeling a lot better.

“We don’t think any question is a dumb question,” he said. That trust is everything when they’re the last face you see before you go under.