Carolyn Holland often bites her tongue and doesn't extend a greeting to people she recognizes at the grocery store.

That's because much of the time, they're former patients. And so much of the time, they wouldn't remember her anyway, and if they did, they might not recognize her without a mask and scrubs.

It's Holland's job as a nurse anesthetist to put patients under and wake them up without feeling like surgery ever happened — minus any subsequent pain from the incisions and procedure, of course.

At St. Anthony Summit Medical Center, Holland is one of nine nurse anesthetists, a specialized type of advanced practice nurse that delivers general and localized anesthesia to patients in the operating room or in the labor and delivery unit.

Together with the hospital's eight anesthesiologists (doctors), they form a hand-selected team that works round the clock, every day of the year.

“The only thing regular is the irregularity,” nurse anesthetist Roxanne Fischer said, adding, “Babies come when they want and take as long as they want.”

Winter is often the busiest time for the team with the most erratic hours. Anesthesiologist and department chief David Lennon said there are more emergency operations in winter, and they tend to be at night. Most elective surgeries occur in other months of the year.

Winter traffic represents the team's greatest challenge and its greatest pleasure: Helping patients. Lots of them.

“It's more of what we love to do — but it's a lot more and it's 24-hours a day,” chief nurse anesthetist Matt Cowell said.

At Summit Medical Center, an anesthesiologist partners with a nurse anesthetist to put patients to sleep prior to surgery. It's the most effective model, proven by several studies, Holland said.

“The benefit is to the patient,” Cowell said. “You get people with vast experience ... who are working with the patient. What you have is a complementing of services.”

To Lennon, Summit Medical's team is the best of the best. He often has a list of people who have contacted him and wait a year or more for the return call about a job vacancy. That makes it possible for him to hand-pick the best candidates.

“We're fortunate to have the best nurse anesthetist team I've ever seen,” said Lennon, who worked at University of North Carolina until he took on the job of building the department at the newly opened Summit Medical Center in December 2005.

A ‘humbling' profession

Anesthesia has been around for more than 150 years, and probably longer, in various forms — including whiskey, cocaine and chloroform.

As the medical world developed, studying surgeons were selected to put patients under. The problem was, they paid more attention to the surgery than the status of the patient — risky, because when a patient goes under, basic bodily functions must be monitored and often supported. For instance, breathing slows or stops when a patient is under full anesthesia, and modern day equipment takes over the process.

Over time, medical professionals sought someone who would be more dedicated to the patient's vitality. They arrived at nurses. In the medical world, today's nurse anesthetists are as qualified to deliver anesthesia as anesthesiologists. And, according to a 1999 report from the Institute of Medicine, anesthesia care is nearly 50 times safer than it was in the early 1980s.

“It's humbling,” Cowell said. “It's your vigilance that keeps them alive during the operation.”

He added that there's the additional challenge of being recruited to and working in the high elevations of Summit County.

“It gives you an appreciation for altitude,” he said, explaining that an added dimension of working in anesthesia in the High Country is knowing where a patient lives normally, as it can affect anesthetic delivery.

An intriguing profession

The Summit Medical team sees their profession as a continually challenging one.

Not that they are always learning how to do the job — many of them have been in the field for more than two decades.

It has more to do with the “art” versus the “science” of anesthesia, said nurse anesthetist Maggie Handlan, who came to the profession from the high-energy job of being a flight nurse. When she retired from flights, she looked for something similarly intriguing.

Incorporating new drugs into the system is always ongoing. As is learning new procedures. Or utilizing patient medical history and their preference to create personalized anesthesia delivery.

“It keeps your mind very active,” Holland said, to which Handlan added, “You always want to learn how to do it better and save and personalize it to the current medications and the patient's existing health.”

An educated profession

Training to become a nurse anesthetist takes years of schooling and clinical work, Cowell said.

Everyone starts with a bachelor of science in nursing, a four-year degree, before stepping into the hands-on, high-pressure worlds of the intensive care unit, emergency room, obstetrics unit and other intensive nursing environments to foster skills.

Eventually, the nurses apply to anesthesia school and spend three years learning the specialty. They conclude roughly seven years of schooling with a master's degree in anesthesia or nursing with anesthesia as a specialty.

A place for camaraderie

It's a close-knit 17-person team working alongside surgeons in the High Country.

They'll joke, they'll sing along to music, they'll enjoy each other's company in off-time, they'll go on medical missions together. All of this largely helps them function well in high-pressure situations. It also helps keep up good morale, so patients feel like much more than a number or a procedure.

“Patients have choices. They choose to come back here,” Handlan said.