In this conversation, Kari and I discuss what led her to a career in healthcare, the importance of trust and communication in an OR setting, and how her passion for service changes lives in Uganda.

Speaker 1: Bringing you conversations with leaders within the operating room and healthcare community. This is Scrubbing In.

Todd Schlosser: Hello and welcome to this episode of Scrubbing In, a podcast powered by SpecialtyCare. I’m Todd Schlosser and today my guest is Kari Zagar, a clinical manager for SpecialtyCare for IONM. In this conversation, Kari and I discuss what led her to a career in healthcare, the importance of trust and communication in an OR setting, and how her passion for service changes lives in Uganda. Enjoy the conversation.

Thank you for joining us here on Scrubbing In. I’m Todd Schlosser and joining me today is Kari Zagar. She is a clinical manager for SpecialtyCare in our IONM work group. Is that correct?

Kari Zagar: Yes.

Todd Schlosser: Awesome. So, I like to start off with this question because it’s sort of interesting to me to find out the reasons people got into the healthcare field. It’s sort of a lot of them felt called to help people and I sort of wonder what story is for a lot of people. So what is it that drew you to healthcare?

Kari Zagar: Yeah. I would say it’s just that. Definitely a calling to help people. I think that working in healthcare is walking alongside someone through a challenging situation, you know, especially in the operating room. Whatever the patient is going through is usually a life changing … it’s a event in their lives that they’re going to look back and they’re always going to remember that day, whether it was a day that they were able to recover from an injury, or just severe debilitating pain, or cancer. Something that, you know, and just walking alongside people through that and being able to support them through such a significant time, and I just love math and science. And the human body fascinates me and there’s just so many systems and there’s so much to learn. And we’re just always learning in healthcare.

And so, just it’s kind of a live science. And I love that.

Todd Schlosser: Yeah, especially IONM. Intraoperative neuro monitoring being so, well I wouldn’t say it’s a new study because it’s been around for a while, but it really is solely digital. So it hasn’t been around like profusion’s been around since the ’30s. You know? It’s relatively new in that realm, so it’s interesting to see how much it’s changing, even though it’s only been around for 40 years or 30 years.

Kari Zagar: Right. Absolutely.

Todd Schlosser: That’s super interesting to me. So was it anything in particular that drew you to it or was it just that you’re sort of a compassionate person and you like to be there to help people through difficult times?

Kari Zagar: Healthcare or IONM?

Todd Schlosser: Well, I guess healthcare in general. Let’s start there and then we’ll get deeper into IONM.

Kari Zagar: Healthcare, probably just the interest specifically in the human body and [inaudible] and systems and how it all works together. And the fact that it’s working with people. I wouldn’t do anything that wasn’t working with people.

Todd Schlosser: I was going to ask that because you love math and science. You mentioned that, right? But when you graduated from University of, was it New Hampshire?

Kari Zagar: Yes.

Todd Schlosser: I stalked you on LinkedIn a little bit. Sorry. I like to prep for the interviews a little bit.

Kari Zagar: Right, yes.

Todd Schlosser: So a lot of people who love the math and sciences tend to go to a research route, but you went straight clinical to working in the operating rooms, correct?

Kari Zagar: Right.

Todd Schlosser: So is it just that love of helping people and wanting to be around people that drew you to that?

Kari Zagar: Yeah, absolutely. I don’t … Working in an environment where I’m by myself or in a lab just never sounded appealing to me.

Todd Schlosser: Yeah, I mean there are people who love that and I’m glad that they can do it because they’re moving the field forward, but I couldn’t do it either. I like people too much. I like conversation, I like, yeah. I just like people too much.

Kari Zagar: Absolutely. Me too.

Todd Schlosser: When you’re working in an OR, in an OR setting, you are attaching electrodes to a body and you’re sort of monitoring those electrical signals. What are some warning signals that you see in an operating room setting?

Kari Zagar: Yeah, so it depends on what modality we would be running. So, it’s very [inaudible]. You could compare EMG, which is muscle activity to something like EKG, which is the beat of your heart.

Todd Schlosser: Sure.

Kari Zagar: And so, if you see the heart beating in the EKG and then you stop seeing the heart beating, you know that could be an issue. So we’re actually looking kind of from the reverse. So in the anesthetized patient, [inaudible] there shouldn’t be any muscle activity because the patient’s asleep. And so, if we start to see muscle activity, that means that there’s some nerve that’s being irritated that’s causing that muscle activity.

Todd Schlosser: And they might be waking up or?

Kari Zagar: That could be a possible thing that’s happening or that there’s something surgical going on that’s causing an irritation or there’s some piece of hardware that’s pinching the nerve, stretching the nerve, all those kind of things. And when we’re sitting there in the OR and we can see it right then and give that live feedback, then it’s as simple as, “Okay. We’ll stop doing that or we’ll loosen the retraction.” Whereas if neuro monitoring wasn’t used for the surgery, then that would probably continue to happen and then we wouldn’t find out about the issue until the patient woke up.
Todd Schlosser: So if someone has a surgery and they don’t have someone who’s monitoring their electrical system or their modalities or the certain modality that you guys were working on, and you know, something is irritated or maybe a nerve is nicked or whatever the negative outcome can be, what sort of things can that lead to when the patient wakes up from surgery?

Kari Zagar: At the very worst, paralysis.

Todd Schlosser: So you guys are there more or less to protect people from getting paralyzed [crosstalk]. Or what other things-

Kari Zagar: Less severe things would be just a nerve irritation. Neuropathy, nerve damage. So patients could wake up with some weakness. A common thing that we’ll see one of the nerve roots is particularly sensitive. The L5 nerve root, so a patient may wake up with a footdrop, which means when they’re trying to walk, that foot doesn’t lift quite as well as it normally would. There’s weakness just in that one muscle.

Also, severe pain. If a nerve is damaged, we’ll see that often. If there’s a screw that’s placed in the spine and it’s kind of pinching that nerve or touching the nerve, then patients could wake up in severe pain from that nerve being damaged or irritated.

Todd Schlosser: I sort of have this in my mind that surgeons are very curt, very to business, right?

Kari Zagar: Mm-hmm (affirmative).

Todd Schlosser: And they want it to be done a certain way and if it’s not done that way, it’s going to sort of annoy them. And that’s probably just something I have to get over and it’s probably because I watched too much ER as a kid, but-

Kari Zagar: Grey’s Anatomy.

Todd Schlosser: Yeah. Okay, so I call that Thursday night football, but we can talk about that later. So I would be nervous to say, “Hey, surgeon, you might be paralyzing this person.” So is that something that you have to just get over. Sort of bite the bullet and just raise your hand or whatever the system is? How do you get over that?

Kari Zagar: Yeah, that can be certainly a challenge. I think that you are mostly right about most surgeons. And all surgeons are professionals. They’ve trained for years and years and years. And so they’re trained. And they’re trained to be very quick and effective with their decision making. They’re not really trained to second guess themselves for a good reason. And so, it’s comes to relationship a lot and then the communication isn’t as hard, but absolutely. When it’s that first surgeon that you haven’t met and you have to speak up, it can be challenging.

I tell all my students it’s courage is a muscle and so, you do it. The first time you speak up and you know, you didn’t die. And it might’ve been a little uncomfortable and you might’ve gotten yelled at, but what we’re doing can’t depend on the surgeon’s reaction. You know, we are there for the patient. We’re there for the surgeon’s aid, but we’re there for the patient and our job is to speak up and whether or not he responds positively or negatively can’t affect what you’re going to do. You’re still going to have to report it.

So, yes, but I guess you just kind of get used to it.
Todd Schlosser: You just sort of have to bite the bullet and do it. And ultimately, you’re speaking on behalf of the patient who can’t speak for themselves. [crosstalk] so there’s sort of an empowerment there I think. You’re trying to make the surgery safer, which ultimately is better for both the hospital and the surgeon just through-

Kari Zagar: Absolutely. He wants you to speak up. As much as he doesn’t want to hear the bad news, he’ll thank you later.

Todd Schlosser: Sure. I’m sure that’s true. So, okay. Let me ask this because you mentioned if it’s your first surgery with that surgeon, it might be a little uncomfortable, but as you get to know someone better or especially in an OR setting, that sort of thing becomes sort of second nature and you become more comfortable. So how important is it to develop a rapport with, I mean not even just the surgeon, but even the anesthesiologist because you might be having to talk to them about maybe the patient’s waking up. Those sort of things. How important is it to build a relationship with those people? Not outside of the OR, but you know, inside the OR.

Kari Zagar: Sure yeah. I think it’s pretty pivotal to have that team dynamic and relationship that everyone values. Everyone has their own role and each role is important and it can’t succeed really unless … If I can’t get the buy in of the surgeon or the anesthesiologist to change what they’re doing based on what I’m seeing, then I’ve … I won’t say I failed at my job, but it’s pivotal for them-

Todd Schlosser: There’s a breakdown somewhere.

Kari Zagar: Yeah, it’s pivotal for them to me to be able to say something and for them to take action to change to affect what I’m seeing.

Todd Schlosser: When you graduated, it was a degree in biology?

Kari Zagar: Yes.

Todd Schlosser: Correct. And now did you know at that point you wanted to do neurophysiology?

Kari Zagar: Not at all.

Todd Schlosser: Okay. So how did you just come upon neurophysiology as a job?

Kari Zagar: Monster.com.

Todd Schlosser: Really?

Kari Zagar: Yeah, I know. Yes.

Todd Schlosser: Wow.

Kari Zagar: Yes. I … It’s crazy.

Todd Schlosser: This is 2009. Was it right after you graduated?

Kari Zagar: Yes.

Todd Schlosser: Okay.

Kari Zagar: I wanted to be in medicine. I wasn’t sure if medical school was the right path for me, so I just started working as a waitress and started looking for other
jobs.

Todd Schlosser: Sure.

Kari Zagar: Like you said, I found a lot of research jobs, lab jobs that I wasn’t interested in. And I found neuro monitoring and it was … I mean, when I got my certification, I was number 2,073 in the country.

Todd Schlosser: Oh wow.

Kari Zagar: So, not many of us. And they were willing to train. Small company. It wasn’t SpecialtyCare at the time and I just called them and interviewed and they told me about it and I said, “That sounds pretty interesting. I like variety and different stuff and working with people and relationships. So, let me try.”

So I had no idea until I got into it and it’s been a blessing. I love it.

Todd Schlosser: That’s so wild. So, and you’ve been with us for a number of years, right?

Kari Zagar: Mm-hmm (affirmative).

Todd Schlosser: And, have you always done and this is something we talked about before we started, have you always done mission trips? Or is that something that’s … you’re just starting to work in? Because I know you’ve just done one.

Kari Zagar: Yes. I just got back from one in July. This is my fifth time that I’ve been on this mission. It’s been the same team, the same mission each time. It’s something that I’ve always wanted to do and I … Things just seem to happen to me that I want, I guess. I didn’t know neuro monitoring was a good fit to me and it just fell in my lap and so did this mission. I was onboarding a new hire in Richmond. I don’t even think he was going to be in the Richmond team. They just sent him to me to train and he was telling me about it.

And he said, “You know, I have kids and I’m not going to be able to go this year.” And I said, “Yeah, I’ll go. Give them my name.” And I went and just fell in love with the team, fell in love with the country, the mission and so I’ve been going since.

Todd Schlosser: Can I ask some specifics about?

Kari Zagar: Absolutely, yeah.

Todd Schlosser: So what country is it? What is it that you’re doing? Obviously Intraoperative neuro monitoring there, but.

Kari Zagar: Yeah, so we go to Uganda and we do spine surgery.

Todd Schlosser: In Uganda?

Kari Zagar: Mm-hmm (affirmative).

Todd Schlosser: Okay. I can’t imagine there are a lot of spinal surgeons in intraoperative neuro monitoring.

Kari Zagar: No, it’s not an option really to have elective surgery there at all. They do things that are burns or trauma if you have a giant hole in your head or something, they’ll operate. Elective surgery isn’t an option and one of the big problems that I think is what started the mission is the congenital scoliosis on the kids. It seems like it might just be cosmetic, but the reality is once their spine folds over and crushes their lungs and eventually they won’t be able to breathe and-

Todd Schlosser: Yeah. I mean scoliosis is your spine obviously and your spine is … you only have one of those. If that’s out of wack, it’s throwing everything off.

Kari Zagar: Right.

Todd Schlosser: Yeah.

Kari Zagar: And eventually, they won’t live a full life. They will probably die in their teens from not being able to breathe, so that’s where the heart of the surgeon who started the mission was and so that’s what we … We go over there with the goal to do scoliosis and we see a lot of different kinds of spine. A lot of trauma. A lot of congenital, a lot of degenerative. We see a lot of things, and I think one of the hardest things is the decision of who to operate on and who not to.

Todd Schlosser: Oh yeah.

Kari Zagar: Because there’s just so many people, but-

Todd Schlosser: Do you sort of just triage out who needs it the most and then take them?

Kari Zagar: Yes. And I’m [crosstalk] thankful that’s not my decision.

Todd Schlosser: Yeah, that’s got to be rough.

Kari Zagar: Seeing the surgeons have to go through those decisions, it seems like … I think it wears on them, yes, but it’s … we’re helping some and make a life difference for the ones that we do help.

Todd Schlosser: And I’m sure loads of people that you’re actually able to touch and help, but I can see why that would weigh on them that … I mean but there are only so many hours in a day and you can’t work all of them.

Kari Zagar: Well we work most.

Todd Schlosser: Well, yeah. No. I’m sure, [crosstalk] but you got to sleep and eat at some point. And you can’t do [crosstalk] that in an OR.

Kari Zagar: Right?

Todd Schlosser: Yeah. Was it just sort of a calling to do that sort of mission work or was it just a need to help people that drew you to that?

Kari Zagar: Yeah probably the calling need. I always have a heart for I guess people who I view are oppressed or don’t have the privileges that I’ve had.

Todd Schlosser: Sure.

Kari Zagar: And certainly in this country, like I said, we have … whether you like our healthcare system or not, we have the ability to get care and you know, globally, there are just so many people who don’t and they just don’t even have an option if they need a life-saving procedure. They don’t have a surgical option. It’s just a death sentence. So, I’ve always had a heart to be involved in that and so once it was offered to me, I just scooped it up.

Todd Schlosser: Is that a once a year type thing or is it whenever they [inaudible] up, you go?

Kari Zagar: Once a year. They are trying to get grant funding so they can go four times a year, quarterly. Just to get more continuative care of the patients there, but hopefully that will come through.

Todd Schlosser: Yeah. Well thank you so much for being here on Scrubbing In. I really [crosstalk] appreciate, Kari. I’ve learned a lot and you’re very compassionate. I enjoyed the conversation. Thank you so much.

Kari Zagar: Yeah, thank you.

Todd Schlosser: Thanks for listening to Scrubbing In. Please take a second to give us a rating on your podcast app and subscribe so you won’t miss out on what we have coming up. See you next time.