Episode 13: Promoting the Environmentally Conscious Practice of Anesthesia w. Dr. Timur Ozelsel

May 11, 2019


This Episode

Interview w/ Dr. Timur Ozelsel

You Will Learn

  • The environmental impact of different gases and other products used in anesthetic care
  • Which anesthetic gases are most damaging to the environment
  • How to balance the importance of attentive clinical care with environmental cognizance
  • How Timur has altered his own clinical practice to minimize environmental impact
  • Timur’s analysis of outdated practice and methodology which unnecessarily damages the environment
  • The structure of clinical administration in European hospitals

Resources & Links

Show Notes

This week I talk to Dr. Timur Ozelsel about his mission to raise awareness among clinicians about the practice of anesthesia in a way that minimizes damage to the environment.  He shares about how living in Germany exposed him to an environmentally-conscious lifestyle, how he has started the Green Anesthesia special interest group within ASRA to address these questions, and about his hopes for the future practice of anesthesia worldwide.

Show Transcript

[[this transcript was auto-generated]]

Dr. Ozelsel: [00:01]Our one vapor which is called Desflurane for example, a dramatic reduce gas impact to one or are they? For example, if I use it for seven hours, a rather high fresh gas flow of two liters per minute, which he said they sold the standard for me folks going to Stella just I produce environmental impacts is if I drove from the north camp and more way all the way down to Cape Town and South Africa. So it just seems that Google maps says we’ll take about 211 hours to drive. I can produce in seven hours of anesthesia time by using that gas.

Justin: [00:29] Hey, this is Justin Harvey, your hosted the anesthesia success podcast. My wife is an anesthesia resident and I’m a financial planner and I work with anesthesia and pain doctors is my clients. This podcast is designed to help the anesthesia community informed about their careers, their finances, and more by taking important questions straight to the experts. Thanks for tuning in.

Justin: [00:52] Hey Justin here this week it was a live in person recording with Dr Timur Ozelsel at the Spring ASRA conference in Las Vegas, Nevada. Timur and I had a really interesting conversation spanning a couple of days and did this interview was recorded on the second day of us hanging out where the timber discussed what it was like as a physician in Germany, how he left Germany because shockingly, he couldn’t afford to raise his family even as a board of the anesthesiologist with a couple of other sub specialty board certifications, but eventually he moved to Canada to practice and in the process became more informed and eventually impassioned about the environmental impact of medicine and anesthesia specifically. And I’ll confess that prior to this interview I knew nothing about this topic, but I just happen to meet Timur, and he was sharing more about this and I, I thought it was really interesting. So some of the statistics that he drops in this episode are downright shocking. You’ll definitely want to stay tuned to the end.

Justin: [01:43] Hello everyone. Welcome to the anesthesia success podcast. This week we’re coming to you live from the spring as we’re meeting where I’m sitting down with Doctor Timur Ozelsel, and he’s kind enough to join me. I met Timur or last night along with his colleague, Dr Rakesh Sondakoppam where they were sharing with me some of the work that they’ve been doing. It helping us understand the environmental impact of medicine, specifically addressing the practice of anesthesia. The thing that made me interested in interviewing Timur has to do with his pioneering work in this area along with some others where they’ve been working to spread awareness and work towards developing solutions. Timur has started the green anesthesia special interest group, which is a a group within ASRA where physicians who are interested in the practice of green anesthesia congregate, share best ideas and best practices and where him and his colleagues are working to move this work forward. Timur, thanks very much for sitting down with me today. To start us off, why don’t you share a bit about your personal background since I know that your life and career has spanned several international borders?

Dr. Ozelsel: [02:38] I was born in the u s and Louisiana. My parents, , Turkish father, German mother who had met and got married in Turkey and my parents had come to the u s to study. So my father had gotten a scholarship at Lsu and so I was born on campus, but shortly after at the age of two, we moved to Germany. Um, so it was my father’s job that had us move throughout the countries. As a child. At age of six, I moved back to the U S and at the age of 10, we moved back to Germany once again and there my parents decided to just have a stay within one school system until we finished it. So he declined all further job offers to move away. And so I grew up in Germany and then for university, I have thought about coming back to the u s at the time, but chose to go straight into medical school in Germany.

Dr. Ozelsel: [03:21] There was some college systems went straight into medical school in Germany and went through medical school in Germany. And so is that a decision you make as an 18 year old? That’s a big, that’s a big decision for a very young man to make. It is. And, it’s something that doesn’t bode well for all young people and medicine. For example, after it’s a six year program in Germany medical school. Uh, so usually after the first two years you take a first big exam and that weeds out up to 50% of all the people who have started in medicine. And, so there are a lot of people find themselves two years into medical school choosing a different path in life. So, yeah, that sounds utterly devastating for a lot of people is, it’s even worse in law school in Germany because they’re the big exam.

Dr. Ozelsel: [04:03] There’s a final exam after five years and may make people fail that and just to columns that they have now basically spent five years studying law and have to choose a new cure at the end of five years. That is brutal. It is brutal. It’s the harsher life of Europe’s sort the same. Wow. But you made it through, I made it through, guided through and so I then went into residency training in anesthesia in Germany, which carried me from the north of Bavaria, but spoke down to Munich where I did my residency and also I met my wife. We had children there together. And I completed two fellowships in Germany prior to them choosing to move to Canada or have been ever since 2007. Okay. In which fellowships did you do in Germany? In Germany I did the fellowships of ICU and cardiac and cesium.

Dr. Ozelsel: [04:48] Okay. And then when it came to Canada, I still added a regional anesthesia and of the transplantation fellowship, which, okay. Excellent. And you came to Canada in, what year was it? 2000 2007 2007. Okay. And what prompted the move to Canada? It’s basically the life of a physician in Germany and Germany. Um, physicians really scraped very hard. Um, the income is the bottom third of all of Europe. As a specialist anesthesiologist, I was barely breaking even every month, you know, and with three little children being the sole supplier provider for my family, I just saw him, no way in the future to achieve any type of personal or academic goals. It was basically, it was, it was a struggle to basically pay the bills every month. And so I had no way to even develop further as a doctor or as a person. And, it was a rather depressing time for me and I knew that I had to leave and start somewhere in India.

Justin: [05:40] That’s kind of shocking to me. So it is Germany on it, like a single payer system. And does that impact the income of physicians or why is that?

Dr. Ozelsel: [05:48] So as a physician in Germany you are salaried and there are hierarchies of the salary. However, the salary is the same for physicians all across Germany. Now big difference is, is that if you live in an expensive city like Munich, like I did at the time, the prices of living, the cost of living is way higher. So if you live in a rural area, you might get by and especially if you have a double income you might get by. But that case I was the single provider for my wife and my three children. And so that’s where I just found that even as a specialist I could only generate extra money by working overtime. So my overtime was paid and I really worked like I worked myself half to death and he has found myself usually on the short end of the stick when it came to just, you know, accounting at the end of the month.

Justin: [06:31] Wow, that is amazing. So you came to Canada for more professional opportunity and to have more financial stability.

Dr. Ozelsel: [06:37] Exactly. And so the one thing I say that Canada has really given me is the joy of my job back again. You know, I was, I actually was on the verge of quitting medicine altogether in Germany. I had actually looked into go into business school and getting a second degree in business to just be able to provide for my family. And so the reasons I chose to become a doctor in the first place have surfaced again ever since coming to Canada. So I’m quite happy in my job again.

Justin: [07:00] What a wonderful thing. So talk a little bit about that transition and what it was like, what the difference in clinical practice was like between Germany and Canada, if there was any. Yeah.

Dr. Ozelsel: [07:08] Oh, there’s a big difference. I think it is the respect that is awarded a physician in Canada as much higher, in Germany. It’s interesting that a lot of people have the perception that physicians are people that make a lot of money, which is not true as I outlined before. And in general I think Germany is a wonderful country to live in this wonderful country to visit, especially, it was quite hard for physicians because on the one hand you had the perception in society that you are this rich person. And on the other hand it was not the case at all. So you had a little bit of the scrutiny of society against you. And one of the things which was for me professionally, a little bit of a problem is that in Germany the you have the pure middle hierarchy. Okay. So we have the professor who is at the top and then you have the next layer, sort of say senior physicians in whatever specialty you’re at, who usually also professors any other like a third tier, which are the senior physicians.

Dr. Ozelsel: [08:08] And then you go down the ladder. So the same, until you are in the areas of the residents and junior faculty and junior staff. And the big problem is in North America we have more of a, I’d call like a swimming pool where basically all start at one level and next year they’re all at that level and the next year all that often after four years when you’re a specialist, at least by definition, there is nobody who is above you anymore. Okay. On Germany you will always have that pyramid, meaning if you even want to get to the next level, if you will have to leave my proverbial a few corpses in your way, you’ll have to elbow a few people who are on the same level with you out of the way in order to reach the next level. And so it’s a system that doesn’t really promote collegiality as much as North American system does.

Dr. Ozelsel: [08:49] So for me, just my personality, it was a fantastic move to be able to move into this type of system.

Justin: [08:55] I’m glad you’re able to make that switch. It seems like it’s been a great fit for you. I’d love to hear a little bit of how you came to start growing in your awareness for the environmental impact of the practice of anesthesia. Well, that’s actually started in Germany. So for example, while I say in North America, smoking is a very unsexy thing. Okay. So the society frowns on smoking in Germany, that’s the case for being environmental. So if you are not environmental, that’s a big social, no, no. And I think it comes from the fact that Germany is a country which has about 83 million inhabitants right now on a very small space. And so things like waste and pollution are surfacing much quicker. So you feel the impact of that much more readily than if you’re in a big space.

Dr. Ozelsel: [09:36] For example, like Canada, Alberta, the province I live in, for example, it’s two and a half times the size of Germany and we’ve down barrier scratching 4 million inhabitants in there. Okay. And so you have lots of space. And so especially if you produce trash, ivantage is, and we’ll never see it again. And so the government has, not really had to implement any rules on waste. Segregation and avoiding waste altogether. For example, back in Germany I had one trashcan that was only emptied every two weeks and if I have produced more trash within one trashcan full, then I’d either have to pay to get extra trash bags to be able to dispose of it. But what it also had to do was I had to separate my waste into recycling. And it wasn’t just that I had one recycling bag where I put on my recycling into, no, they were actually, I had seven different trash cans in my house where I separated waste already.

Dr. Ozelsel: [10:22] And then when I further took her to the recycling facility, which adds did in myself, I usually had to split those seven bags one more time to end up at about 1415 different elements of recycling. Wow. That were actually then followed up through. So what are maybe a couple of the groups of segregation when you’re separating ways? So for example, already when you look into the paper, you will have paper, regular paper, which could be newspapers, write your paper, anything. But cardboard is already for something totally separate from that. And then when you go into glass, for example, you had greenglass brown glass, white glass and that was all separated from one another. Then when you had metals, aluminum would be a totally different stream than the other metals. Then you had electronic waste and the different plastics. Also you had soft plastics, hard plastics that were separated two right at the outset.

Dr. Ozelsel: [11:04] So it was a good education was put that way into why this is important. And also the government itself in Germany subsidized very many what I call green initiatives like solar energy for example, Germany is a country where the sun doesn’t shine a lot in Germany is the world leader in solar energy. I do. This says because the government subsidizes that a lot. And, also the government after the nuclear disaster in Japan, a few 10 years ago, 12 years ago, Germany had to decided to completely get out of nuclear energy and nuclear energy was already highlighted green alternative to the coal powered energy that they had before. So the renewable energy sources are heavily promoted in Germany and it’s just the general mental state of mind that you adopt when you live in Germany. So being green is something that comes natural to you. Right. And so when I came to Canada I was, and I’m going to say I was appalled, but I was shocked how little people cared about this. And these are all good people, you know, these are good people who just have never really come into contact with the idea that you would have to do something to preserve the environment.

Justin: [12:11] Right. Interesting. So when did you begin to grow in awareness of the practice of anesthesia and the environmental impact?

Dr. Ozelsel: [12:19]Yeah, that was interesting. It’s data around the impact, especially of our inhalational anesthetics was already available towards the end of the nineties early two thousands when I was just beginning my career in anesthesia. So I started MCC on 1998 and I do, their data was available. However, I never really came across it until around 2007 when I was already practicing in Canada. And I read up on the articles a little bit and was shocked. Our one vapor, which is called desk flow and in for example, as a dramatic greenhouse gas impact one or are they, for example, if I use it for seven hours at a rather high fresh gas flow of two liters per minute, which is sadly sold the standard for many practicing anesthesiologists, I produce environmental impact as if I drove from the north camp in Norway all the way down to Cape Town in South Africa.

Dr. Ozelsel: [13:05] So it distance that Google maps says we’ll take about 211 hours to drive. I can produce in seven hours of anesthesia time by using that gas. Wow. So that is incredible. It is. It is. It is incredible because that is a good word for it. So I knew that we had to change our perception and it is really interesting if you look at healthcare because we strive to do better by our patients. It is our calling is why pretty much all the people who are in healthcare are in healthcare to do well by their patients. However, we, I think I’ve lost track of trying to look at the big picture of what is going on or there are focus on the individual has become so great that I sometimes will say it’s like we’re not even looking through a magnifying glass in our patient anymore. We’re actually looking through the electron microscope into our patient and our field of vision has become extremely narrow. So for example that in anesthesia we’re using extremely potent greenhouse gases to provide insights for our patients is actually a sad joke, right? Because on the one hand we are doing well by our individual patient. On the other hand, we are heavily contributing to the environmental crisis, which ultimately is threatening for all of mankind.

Justin: [14:13] Yeah, that’s very interesting and this is kind of touches on something we’re cash and I were discussing at length last night, which is in the United States there was a sort of a hardwired cultural distinctive where a lot of what American’s pride themselves on is the individualism. It’s been called the land of opportunity. Like you can come here and you can do whatever you want to do. You as a person, the American dream. That’s right. And it’s in many cases kind of divorced from a more community oriented others oriented mindset at times. I’m interested in, have you, have you perceived that dynamic at all as you’ve practiced in and come down to the states on occasion for

Dr. Ozelsel: [14:53] oh I see. Everyday in medicine I have to say, you know what, ultimately there is nothing wrong with the American dream per se. The one big problem is that the American dream in the sense that an individual can use every opportunity she or he has to achieve dreams means its limits. When you look at the world population, all the things we do in our everyday lives would not be overly dramatic if we had less than 3 billion people on this planet. But we are by now burning through, I’m not sure. Have you ever heard of the term of the resource turnover date? No. So the planets, if you will, we’ll be able to produce a certain amount of resources per a year. And until around 1980 the planet was able to produce more every year than humanity used. Now ever since 1980 we consume more than the planet is able to replenish every year by now there is turnover date.

Dr. Ozelsel: [15:41] So what the earth can produce every year before we basically go into to its bank. Its reserves worldwide on average is around mid August by now. But if you look at the u s and Canada in particular were early February. So Oh my goodness. In Canada basically by February and burn through the resources of the planet can replenish for one year and then the rest of the year we basically live on reserves, reserves being the surplus of other countries essentially. Well, well what the earth has to give, right? And so we are, we’re exploiting the planet mercilessly right now and ultimately it is leading to a complete health crisis. Not sure if you’re aware, but like the United Nations points out that global warming, the climate change and all the things that go with it are the most serious threats to human health in the 21st century and something that actually cannot be and should not be ignored any longer.

Justin: [16:34]Interesting. With regards to you beginning to be aware of these things, you’re getting familiar with this research and the late nineties and two thousands talk a little bit about how you’ve started to discuss it with your peers and integrate these principles into your own practice to be more cognizant of these, of these things.

Dr. Ozelsel: [16:52] Okay, so the first thing that I really did was change the old practice and I think that’s where it starts. You always have to start with yourself and see how you can change your own practice before you can even ask others to consider changing their practice. And so I changed my own practice and I unfortunately found it wasn’t hard. It wasn’t hard at all. I will confess that I loved using desk Lorraine up until the day I read about its impact and they loved using nitrous oxide, which is another big bad boy in this whole discussion and I started reading a few papers, some that had come out out of the u s actually there are some phenomenal doctors from the US who have done a lot of groundbreaking research in that area and have names like Susan Ryan out of San Francisco has since retired or Jody Sherman out of Princeton.

Dr. Ozelsel: [17:30] They’ve done a lot of good work in their articles to read on this and so I read those and became more interested in what I did for myself in 2007 when I read the first literature on that. So I quit using Desflurane overnight and I know that it, that’s a step that many nieces this are very scared of because this is perceived in a society. The lean body weight is getting less and less so it takes our patient population. Desflurane is still said to be the one that will provide quickest wake up time because it doesn’t enrich and had it posted in fatty tissue while Steve of rain for example, which is the most commonly used one worldwide in which also has our lowest environmental impact actually enriches in adipose tissue. So people are afraid that if they switch, especially on the obese patients, they can’t wake them up as quickly.

Dr. Ozelsel: [18:14] So many studies have showed that all you have to do is become really an expert in understanding how to use the vapor and then you will basically achieve the same wake up times like a pure for user cannot wake up their patient any quicker than I can wake up mind by using CBOE flooring no matter what the body mass index of the patient it is. So I changed her own practice and found it to be very easily doable. It really is very easy to do. It’s nothing that anybody needs to be afraid of that will impact your practice in any way. The same for using nitrous oxide. Nitric oxide is the gas that we’ve had longest ever since. Really almost for a hundred years. We’ve had nitrogen oxide right now. It usually was called laughing gas before and really hadn’t entered anesthesia as much as is or was then for a while, is fortunate declining right now.

Dr. Ozelsel: [18:55] But worldwide nitrous oxide still has the biggest greenhouse gas impact of our gases and there’s also the number one ozone depleting substances in the atmosphere right now. So I basically changed my own practice and decided now it’s time to reach out to others. And so the first thing was able to do was in our residency training program, we give lectures to the junior residents coming in. Um, I was able to give the lecture on inhalational anesthesia. And so where the lecture before had been focusing a little bit to on the effects of inhalation anesthetics for our patients. I only brushed over that initially and said, you know what? There is many things that you read in books and I’m not going to bore you with stories about how the physics and how you produce these and what they do because you have read all that and the books.

Dr. Ozelsel: [19:36] Anyways. So I’ll tell you about the things that I think you need to know and that’s what the impact of these guests are on the environment and how to mitigate those in your own practice. Right? And there are many ways to do that. First of all, it’s the choice of the volatile, like I mentioned before, but you also can do things like running minimal fresh gas flows because there are many things that we are tied, particularly in the US. For example, if I take civofluorane see off rain is, as I mentioned, the most commonly use vapor worldwide. However, when it was introduced in the 90s there was a debate about a chemical substance that was produced when Siebel throwing interacted with the chemical absorbent that is supposed to extract CO2 from the system. And so a substance called compound a was produced, which in rat models have been shown to be nephrology or kidney toxic.

Dr. Ozelsel: [20:21] And so the u s was the first country to put out a guideline that you needed a minimum of fresh gas flow that would accompany the use of Siebel for rain to wash the compound eight out of the system, so not remain within the patient. Now the literature that the LED’s to that decision is heavily disputed and we were actually, our group is about to release a med analysis to show that there’s most likely nothing to worry that you can use seal friend every fresh gas flow. Most countries actually saw this evidence and by the late nineties early two thousands had abandoned all fresh asked for recommendations, foreseeable terrain. The U s even itself went back in 1997 to regulate the recommendation from two liters down to one liter, but countries like Canada for example, has still remained with a two year refreshers for recommendation. Now, this is only a recommendation.

Dr. Ozelsel: [21:08] Awesome. Based on outdated data and we know really from literature evidence and also how our absorbance today, which don’t even produce comp on the animal, see what the rain, that there is no danger to our patients. Yet the teaching persists and a lot of anesthetists I, or even speaking to colleagues last night who said, I still can’t get over the fact that I’m supposed to Uco frame of less than two liters. It’s basically ingrained in the minds of a lot of people that use it. And so this is where we have to then start effecting change and of course it starts with teaching the next generation, but also reaching out to our colleagues who are going to prices for many years and seeing what, I understand that you’re doing it for all the right reasons, but these reasons actually turn out to be non reasons. Okay, so you can and you should change your practice.

Justin: [21:48] What would you say to the clinicians out there who say they’re throwing is my favorite and I don’t want you to take it from me cause I feel like it’s the best for my patient. And all of your postulations about what may or may not be true, make me uncomfortable. When I think about, I want to make sure that I’m doing what’s best for right.

Dr. Ozelsel: [22:02] It’s totally understandable, especially if you’ve been in practice for awhile and is your go to vapor. It’s a sentiment that is completely understandable yet you have to try to see the bigger picture here. Right, and I can only encourage every practicing anesthesiologist. If you are able to practice as a specialist anesthesiologist, a change to see what fluorine or to ISO chlorine, it’s not beyond you is something you can do with ease. There’s something where you will be uncomfortable initially because you’re doing something that is outside of your comfort zone. Right now you’re using the different vapor and yet this is something that every practice anesthesiologist really can achieve with ease. It’s just something that you would need to want to do.

Justin: [22:41] Tell us a little bit about the special interest group that you’ve started with an ass or what is the special interest group and what motivated you to use this platform to continue to get the word out?

Dr. Ozelsel: [22:49] As I said, it was started with the residence there was trying to teach and I started giving lectures on this topic too. And fortunately there’s for example invited by colleagues out of Asraq who practice in New York and also for special surgery to come and give grand rounds as a visiting scholar. And so all the lectures I gave were very well received and so people were encouraging me and said, you know what, I think you are promoting an important message and more people have to hear about this because we just don’t know about this. And it is a topic. While it was published in the literature, there’s so much literature to read that most people have skimmed over it. So it was more something that, for example, I can only claim I stumbled over it by accident. It wasn’t that actually sought out to see if there was literature on this.

Dr. Ozelsel: [23:28] I stumbled over it by accident and when I read it, that’s where I tried to find more. And I found that there was not much out there. So in this term of trying to reach out to colleagues two years ago at the Azure, a spring meeting in San Francisco, I spoke to some of my direct colleagues and Bactroban Sui, who has been really a long standing faculty and as her for awhile. So if you know what, why don’t we actually start, see if we can start a special interest group about this because the anesthetic with the lowest environmental footprint as we know it right now, even though there’s no hard evidence to show it by, by all logic, it is. So it’s just providing a region has said it. So avoiding general SETL together and using the specialty of reason and a season to provide nerve blocks and to either completely avoid general as all together and do this basic with maybe a week or just sedation or even if we use a regional anesthetic and general anesthesia, we can run the gentleman aesthetic at a much lower rates than we would without the regional anesthetic.

Dr. Ozelsel: [24:21] And so we presented it to the president, so Kumar, an Andrew, and he, was actually quite intrigued by our idea of starting special interest group and said, this is a very important topic. I totally agree. I encourage you to go ahead. And so we sought out members as a requires a certain number of members to come forward to say I will support the creation of this special interest group. And so especially interest with was created in November of 2017 was a bit of a slow start because obviously as I said, this is not a topic that everybody’s familiar with, but it is a topic that is really catching fire here right now. So within one and a half years, we have our membership grow from the original founding 22, now 351 now. So people are taking notice. So it was about $4,000 zero members. It’s almost 10% of the Azure membership where members of our special interest group right now and this morning for example, we had our second meeting of the Spanish an interest group and the room was full room was full of people and I was very happy to see this. I see that more and more people are taking notice and are coming forward with issues like the all the disposables in their hospital and coming forward with things that are being basically mandated by management for perceived financial interests, not really patient interests or global health at large.

Justin: [25:38] Yeah, it makes sense. Interesting. So if I’m a a young physician and I’m interested in learning more about this, maybe I’m not a member of Hazara or this is all new to me and the environmental impact of anesthetic gasses is something that I would love to learn more about. What kind of resources out there might you recommend as far as starting this learning

Dr. Ozelsel: [25:55] For every young anesthesiologist, there are actually some nice documents rights within the u s that they can start it with. So the Asa, the American started, the anesthesiologist has a green anesthesia task force which put out guidelines on the practice, which are really good. They’re very good guidelines. They’ve been updated once ever since they were created first. So I think 2017 is the most current version of these asa guidelines and there are a fantastic starting point to read them and to get an idea of what’s going on. And ultimately by now a literature search, we’ll easily yield many articles, container topic. And if nothing else you can always shoot me an email and I’ll be happy to get you started. Or did you guys get in the right direction

Justin: [26:37] and where can listeners reach you via email? What’s the best email address?

Dr. Ozelsel: [26:40] So the easiest way to reach me is just by my last name. It is ozelsel@ualberta.ca. Okay. And we’ll put that in the show notes as well. So I know I’ll be happy. As you said, this is a passion of mine and I think currently I do think it is the most important topic in health care for sure. Maybe the most important topic in politics worldwide. There’s this young girl as Sweden that I’m sure that a lot of your listeners will have heard of Greta Thunberg’s who just recently was even nominated I think for the Nobel prize. She’s a 16 year old, highly functional autistic girl who has done amazing talks and really just they come from for heart. There are a lot of Ted talks out there on the net, so google Greta Thunberg’s ted talks. You will hear some amazing presentations of a young woman who talks about the environmental crisis and it’s going on and how she is a young woman cannot understand why not everybody’s in panic mode and trying to really solve the most blatant and obvious issue that the world faces today. Yes.

Justin: [27:39] That’s very sobering when you put it in those terms. Well Tim or it’s been a pleasure speaking with you as we bring things to a close here. I love to hear just a brief anecdote of a time for you, when you considered all of the, I mean you’ve you, your expertise spans international borders and the different fellowships that you’ve done and obviously this focusing green anesthesia you’ve accomplished a lot. Maybe you could just zoom in for one minute on a time or a place where you said in reflecting on some of the things you’ve done, this is something that I’m proud of. This is something that I am grateful that I’ve been able to bring attention to or to accomplish with my career and my education.

Dr. Ozelsel: [28:17] Well, I think there’s not even a single time, I have to say, I think it is the growing, like this morning when we went into the special interest group meeting and I saw all the people sitting there, I felt a moment of pride for say, wow, this is, this is going well. I have to say this is, you know, there is no guarantee what will succeed in our mission, but we have to start somewhere and communication and education is the really only good venue I know of to achieve ongoing success. And actually we would promote success in our mission to raise awareness and to change the ways we live and we practice. And so I don’t even have to go very far back. You know, I’ve had a few of those moments, but this morning when I saw the whole room full of people who were willing to take the next step forward is a very proud moment for me.

Justin: [29:02] Yeah, that’s gotta be really encouraging as you consider what the future may look like for the practice of anesthesia and the cognizance of what green conscious anesthesia looks like that that it gives you some sense of hope, I would imagine. Yeah, exactly. Great. Well doctor Timur, thank you very much for joining us on the anesthesia success podcasts.

Dr. Ozelsel: [29:19] Pleasure. Absolutely. Thanks.

Justin: [29:24] Hey Justin here. This may shock you to learn, but I am actually not a fulltime podcast. I also run a financial planning company called quantify planning, where I work closely with anesthesia and pain docs to build and implement customized financial plans. If you’re interested in working with a financial planner who knows of the ins and outs of your profession, shoot me an email or head on over to quantify planning.com for more information. If you’re a resident or fellow, I can also offer you a free student loan analysis if you’re interested, but there might be a waiting list, so check out the link over there to see if you’re interested in learning more about the topics we discussed today. Head over to anesthesia, success.com to join our community of residents and attendings and others to ask a question or get more free resources. If and only if you liked this episode, please leave us a review and subscribe. Thank you very much for listening to the anesthesia success podcast.