This interview introduces Dr. Anor Hidayah, an anaesthesiologist with the Malaysian public health service. She is a full time medical practitioner, who still finds time to engage in medical science communication and public education as a published author.

Dr. Anor Hidayah is based in Malaysia.

What is this interview series about?

The 21st century will inevitably be a century of change. The excesses of systems we invented throughout the Industrial Age to solve the problems of the past, amplified in the 20th century. This resulted in instability of the Earth’s climate systems, as well as of the living systems of the planet through biodiversity loss, which are known as the Climate Crisis and the Biodiversity Crisis.

Reversing these planetary crises requires changing those systems to become sustainable, ideally without reviving the pre-industrial age problems that spurred its unchecked growth to begin with, such as lower food production & availability, limited access to healthcare, and reduced quality of life due to the poverty trap. In order to do so, we need to understand which jobs must be created, and which ones must change.

This interview is intended to give some insight to people looking for employment in the landscape of the future sustainable world. It is not meant to be career advice; not all jobs explored in this series are common today, or in your location. Rather, it is to expand your mindset on new job possibilities on the horizon, and what livelihood can mean in the future. For a more detailed description of this interview series, go to the Jobs on the Horizon archive.

I asked Dr. Anor to describe to me what a career as an anaesthesiologist is about, and how it’s changing in response to the climate and circularity transition efforts. Here’s what she said about “green anaesthesia”.

What does an anaesthesiologist do?

An anaesthesiologist is an expert with extensive knowledge of human physiology and the disease condition of organ systems both under normal and stress conditions. They are trained to mechanically and pharmacologically influence the human body system, to support patients in critical care as well preparing them to undergo surgical procedures.

My responsibility is to ensure patient safety during any procedure or surgery, whether by doctors or paramedics. In addition, my commitment is to alleviate the pain and anxiety of patients upon undergoing invasive or semi-invasive procedures inside the Operation Theatre (OT).  

We cooperate with various departments in the hospital, be it physicians, surgeons or paramedics. The changing image of the anaesthesiologist has emerged as a physician or surgical-based clinical specialist playing a crucial role in the team management of unconscious and critically ill patients, rather than confined to the operation theatre. Its essentially involved in the patient’s comfort, safety, and pain relief. 

Why does anaesthesiology need to change?

The global healthcare contribution to the greenhouse effect was found to be as high as 5%. Studies in the UK found that 3% came from anaesthesia practice alone. So, worldwide, there is more awareness of the need to reduce our healthcare- and anaesthesia-related environmental emissions or carbon footprint without compromising patient safety and quality of care.

Anaesthesia and greenhouse gases

Anaesthesia has contributed to significant global carbon emissions. This increased further during the COVID-19 Pandemic, when we needed to use more single-use Protective Personnel Equipment (PPE). Medications used during modern anaesthesia include Nitrous Oxide (N₂O)* and volatile agents like desflurane. The latter is a hydrocarbon with a Global Warming Potential (GWP) 2540 times that of CO₂. These gases are released into the atmosphere and thus contributes to climate change.

Healthcare sector and waste

I realise that before, we have been reminded of sustainability and reduction of the greenhouse effect in our daily practice. But plastic gloves, needles, syringes, and PPEs like masks, gowns, and tissues were not used sparingly, given the worry of transmissible infections, and both patient and healthcare worker safety. Perhaps, working in a government hospital setting where patients are not charged based on equipment and medications used, but are well subsidised by the government, provides less drive to the sustainability effort and cautious practices.

Healthcare sector and chemicals in the environment

In addition, we use considerable quantities of drugs. We discard them at the end of the procedure or patient management, leading to wastage without us realising it. This would subsequently lead to environmental hazards without a proper waste system, especially when discarded into the sewage system. 

We realised that we could try to be cautious and think before using our medical equipment, energy, and water supply. We can practice appropriate use of medication and proper waste management which does not even endanger our patients. It can be encouraged over time to all healthcare workers during our daily practice. 

How is the anaesthesiologist profession changing?

The amount of anaesthetic agents (note: with climate impact) was determined around 10 years ago. These showed significant accumulations of longed-lived greenhouse gases ranging from 1 to 14 years. Since then, there are many calls towards environmentally sustainable anaesthesia. This involves widespread awareness of our role in the need to reduce CO₂ emissions across healthcare practices. This also involves the development of guidelines and shared decisions to prioritise climate protection. 

Anaesthesia Day is celebrated every 16th of October. This year, the theme was “Green Anaesthesia Now or Never”. The Malaysia Anaesthesiology Society is taking the lead in this effort by creating awareness among our healthcare workers. A pledge list was put together to show solidarity in supporting environmental sustainability in our daily anaesthesia practices. 

So, we will try our best to incorporate the environmental sustainability principles into our practices where the 6Rs (Rethink, Refuse, Reduce, Reuse, Recycle and Research) waste management principles are emphasised. We also try to reduce the unnecessary usage of volatile agents, especially N₂O and desflurane, and encourage the use of regional anaesthesia** instead of general anaesthesia. Another example is the use of washable gown and cap instead of single-use.

We are taking positive steps to reduce our daily carbon footprint and raising awareness among fellow associates, trainees and staff.

The global healthcare contribution to the greenhouse effect was found to be as high as 5%. Studies in the UK found that 3% came from anaesthesia practice alone.

– Dr. Anor Hidayah

What do you do as an anaesthesiologist? What does a typical week look like?

Work typically starts earlier than 8 am as we need to prepare the patient for surgery in the operation theater. Coming earlier just to check the ventilator and all other equipment works perfectly before starting the morning case is vital to the patient’s safety. From one case to another case of patients of different ages undergoing various types of surgery and procedures. 

Some days, we need to do on-call for 24 hours. This means staying at the hospital seeing patient after patient, covering both ICU and operation theatre. I always tell my junior doctors that we are the guardian angels of the ICU and the operation theatre. The patient came to the ICU in an unwell condition, feeling suffocated and helpless. Thus, we are their last hope to save them. So, we plan preemptively and make sure everything is according to the plans. Then, we monitor vigilantly and are always on the go for any crisis or worsening matters.

Best thing about being an anaesthesiologist?

Ever since I worked in this field, I never give up on life. I have seen so many patients like ‘nyawa di hujung tanduk’^ on multiple life support systems and medications, but their life eventually improves because we never give up on hope and prayers. Even with the slightest chance of survival, there, we hang our hope with the help of family support and prayers. Even in the worst conditions, we have someone to hang on, to talk with and to share our difficulties to somehow ease the burden on our shoulders. 

Worst thing about being an anaesthesiologist?

Looking at the patient on their death bed, surrounded by small children crying for their parents. Breaking bad news to relatives is one of the hardest things to do. I couldn’t help but cry, in tears in that situation. Losing a patient after surgery can keep our mood low for some time. This kind of life-and-death situation makes us realise that some things belong to God and not in our hands.

How much can someone earn as an anaesthesiologist?

For an anaesthesiologist working in a government setting, the salary ranges from MYR10k to 25k per month, depending on the years of service. While in the private sector, the salary can increase up to 6 figures. 

What are the future career prospects for an anaesthesiologist?

Now, the number of anaesthesiologists in the population is about 1 in 5. Our country aims for 1 in 3 ratio.

More and more anaesthesiologists chose to transfer to the private sector in view of more income. However, over time, the private sector might be saturated. 

Ever since I worked in this field, I never give up on life. I have seen so many patients like ‘nyawa di hujung tanduk’ on multiple life support system and medications, but their life eventually improves because we never give up on hope and prayers.

– Dr. Anor Hidayah

How did you get into anaesthesiology?

A career in Anaesthesiology requires training, starting as a medical student for 6 years, housemanship for 2 years, then Medical Officer for at least 1 year, and a master in medicine which is 4 years. The total training usually will be about 10 years, before being considered a specialist in anaesthesiology and critical care. 

What kind of person would do well in anaesthesiology?

Working as an anaesthesiologist is undoubtedly stressful. We are handling all sorts of patients who need to undergo a procedure or operation. Every operation carries mortality risk of 0.5% in the average population, up to more than 90% for patients with multiple comorbidities and unstable conditions.

The need to be on-call for more than 24 hours without proper sleep, even sleepless nights, while at the same to maintain good judgement and energy requires a suitable coping mechanism. In addition, we need to balance work and family matters, especially those with many children and those who need to care for elderly or sick family members. Good family support, coping mechanisms, teamwork and maintaining a good working environment are the ingredients for success. 

Not to forget, this expertise requires combining skills, knowledge and experience, remembering empathy, vigilance and agility by mastering the arts of anaesthesia, resuscitation, and communication. 

Suggested further reading / learning for an aspiring anaesthesiologist:

Read about my life experience during the COVID-19 pandemic on the actual stressful conditions when my family was struck with the COVID-19 virus, while at the same time, the heavy burden of being at the frontline to manage the critical care of COVID-19 patients going for operation and in the critical care unit in the hospital. From this book, you may evaluate the hardship, patience, and perseverance needed to keep going during a crisis. 

I have also dedicated myself to writing the information and knowledge to make it easier for the community to understand more about anaesthesia in my recent book Pembiusan: Tanya Pakar Bius.

For those who would like to pursue master in medicine, I am the co-author of Rowi’s Anaesthesia Teaching Book. It is suitable for medical officers who work in the critical care line and anaesthesiology, specifically. 

Further reading for sustainability and green anaesthesia. See also this article: Schuster M, Richter H, Pecher S, Koch S, Coburn M: Ecological Sustainability in Anaesthesiology and Intensive Care Medicine. A DGAI and BDA Position Paper with Specific Recommendations. Anästh Intensivmed 2020;61:329–338. DOI: 10.19224/ai2020.329


* Nitrous oxide has a CO2e of 286. For an explanation on climate related terms, check out my cheat sheet article.

** Anaesthesia that makes an area of the body numb, rather than rendering the patient unconscious.

^ Malay proverb, literally: “on the tip of a bull’s horn”. An equivalent expression in English is “hanging by a thread”.

Did you know that anaesthesiology’s impact on the climate is not insignificant?

Interested in exploring the career path of an anaesthesiologist or anaesthetist? Pin for your job inspiration. If you would like to share your Job of the Future, contact me here.

US style corporate management promotes senior managers who see staff in terms of their job grade, like parts in a machine. So if two people happen to be in the same job grade, therefore they must be interchangeable.

As a kind of LOTR fan, I have to nitpick the phrasing and clarify that the reason why the One Ring was the least dangerous with a hobbit, is because hobbits just want to live life and get along, ie hobbits aren’t tempted to “rule them all”.

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