July 1, 2026 Salus Health Care Forum

Mark

Interestingly, the FAA, which monitors the airline industry, is the agency from which we adopted the Anesthesia Check List. You’re right. If we were more tuned in and adopted the FAA guidelines throughout the flight—and throughout the Anesthetic process—that I think patients would be more attuned. As someone who is double-board certified, I often get questioned: Why are you explaining the surgery to the patient more than the surgeon does. However, that’s not the general rule at all. Usually, the staff member applying the anesthetics says nothing to the patient about the actual surgery.

Jack

This is fascinating. Thank you for bringing this issue up. My first decade of research was on carotid artery endarterectomy. So when I was doing the lit review on that, I stumbled upon this finding that 50% of males over 50 who have open heart surgery have a major depressive episode within the first six months after their big surgery. So we included the assessment of mood that in our outcomes research. We included that sort of assessment in the projects that we worked on to such a point that when I was a medical chief of a little Obamacare insurance company in Colorado—a nonprofit cooperative–we actually required a mental health consult prior to open heart surgery. It was at the time insurance required this for people having transgender surgery. We only required one assessment, but we also required it for people getting open heart surgery because we wanted them to already have the relationship with a behavioral health expert prior to waiting six months down the road. No one knows what’s going on. Why are they falling? Why are they about to commit some self-harm? And that was very important in my life, making sure that people who were having surgery.

Now, I have a question about the impact of surgery and anesthesia on the actual biochemical response of the body. What are the impacts of the anesthesia, the fat soluble, not fat soluble that this and that versus a person coming to terms with their frailty and mortality and the major surgery brings into clear focus? Having had heart surgery, the issue of morality came  into clear focus for me. Oh my gosh, that was a big deal. I’m curious about your experiences and what the available information might be.

Gay

This is a hard one to comment on because I don’t have a lot of experience in this realm with people post-surgical and dealing with people and their frailty. But when, as a clinician, I think about how much of that has to do with their narrative about their life story and not just specifically a major event like heart surgery. I think having to deal with an aging body and our frailty plagues us all at some point and at some time. It may become reach a clinical level and it may not. Or it may become clinical and we don’t seek clinical help due to a whole host of other things. We’re too proud. It’s not part of our culture. And there’s a number of reasons that we don’t get help around it. But, the interesting fact that you mentioned, Jack, concerns rates of suicide. The highest rate of suicide still year after year is found among white men over 50. This is really alarming, when we think about it in our country.