Career Perfusionist [14] The Occasional Moment …

Perfusion is a very hard yet calculated field of endeavor.  To get there- well that’s hard.  Actually very hard.  When I interviewed, it was 4 candidates out of 250 + applicants.

Does that mean you are better?  Cream of the crop type of stuff?  Are you the best thing that has ever walked and knocked on the door to enter the cardiovascular arena?

Probably not.

Just means that on a given day, at a particular moment, something struck a chord.  Somebody from somewhere else, in some other space in time, somehow decided that just maybe you were indeed more than a number, and you should fill a seat at a table for few.

Or maybe you were an academic accident- a filler for somebody that bailed on their seat into the exclusive club- and you were the left overs.  Second to none I suppose.  But anyway you were picked.  You became the substitute… but who cares?

You are in- and 3,000 cases later- you are still in.

Way to go.  You just CHANGED your life.

I was THAT guy….  The filler space.

That’s how I got in.

No clue about perfusion.  Had watched 2 hearts in my life.  Was bored to tears on case number 1, but was was thoroughly and profoundly moved  as I watched the harmony of acceleration, movement, and poetic calm that the man (CCP)  in front of me demonstrated as he came in on an emergency.

God he was quick.  And so efficient with his movements.

Perfusion Breeds Speed

Physically and cognitively.  Pure speed to stay ahead of whatever is unimagined yet.

This was in San Diego somewhere.

I played a lot of ball as a kid , high school, Navy, and beyond that.  So watching other people perform- and perform well is something that is earned by example, and not based on paper credentials.  And watching this man just put it all together so quickly, so precisely, and so damn confidently, well that made me want to sign up right there.

There is something easy to recognize- poetry in motion and grace under pressure.  I saw both that day- and I am certainly a harsh critic.  It is something I always expected in myself- therefore a pleasure to watch in someone else- to the point of raising the question of whether or not I could actually do something like that?

I had a lot of medical experience- and was the best at what I was doing in terms of 1st assisting, Navy ER medicine, all the stuff that was a dollar short of going to Med school- but made a difference in terms of performance and end results.

Going further was limited by a few things in my life.  Loans weren’t available for people with my background.  I was at the tip of having to make a decision- or un-become myself- and remain status quo.

Forget Med school.  I wasn’t going to be a nurse.  Didn’t want “assistant” as part of my title for a career, and was a pretty cocky somebody that felt I could outdo anybody at anything.

Somebody’s Got to Do It …

The perfect mindset for perfusion school.  Got to be confident, to overcome your own ignorance in the process of becoming the “somebody” that is going to put somebody else’s loved one- on bypass- and NOT make foolish mistakes.

And it is exactly that, the fact that it IS somebody else’s loved one- that makes me pause and consider the impact of failure should I not succeed in a pump run, should I miss a clamp, should I fail to overcome in a few seconds of time-whatever malfunction I am seeing- or recognizing, or confronting.

The caliber of a Perfusionist is measured in seconds…

There is an instant- a visceral moment when you have launched on bypass, and your evaluation sees things that you may not understand, but your gut instinct knows something is OFF- or not RIGHT – and several things occur at the same moment:

You temper the following questions:

• Am I seeing what I am seeing?  In other words- is it real?

Continue your scan and verify…Have you ever seen this before?

Do efforts to correct the problem work- or is it still undefined?

• Have I made a critical error in my setup?

Either trust yourself or realize you messed up- and identify it and fix it.

• Is the pump functioning appropriately-?

No mechanical errors-

No it’s not- But I don’t know why…

Eliminate the crucial suspects:

• Lines reversed
• Power cords are not connected
• Lines are kinked- or clamped
• O2 Hooked up
• Clot Free
• No Aortic Dissection
• Forward Flow (you are generating a cardiac output)

This is YOUR MOMENT

To succeed

Or Fail

This is when you find out what you are made of.  Are you honest?  Can you be humble and accept a mistake for what it is- and NOT what it isn’t?

Will you be decisive and make a choice for the patient irregardless of further ramifications external to what is in front of you now- a patient’s life rests in your hands.

Will you ask for help if you need it?

IF

It’s

Not

A Mistake-

Are you bold enough to make a quick decision and take charge of your side of the equation?

You need to think quick- because whatever you decide will be the fate of the patient as well as your unclaimed doorstep to the future you dreamed of.

People have come off bypass before, and changed out an oxygenator- only to go back on and have the fatal realization that the entire time- the the O2 was disconnected.

It takes a few seconds to miscalculate and kill- a lifetime to reconcile it.

If you have the same heart as the courage the patient demonstrated to allow you to be a part of saving their lives- and possess the honesty and the moral strength to appear weak when making a strong move to salvage a potentially lethal event- well that is when you can yourself a perfusionist.

It’s Called a Tunnel for a Reason

Tunnel Vision : Narrowing of cognition when fear implodes instinct and what you would normally do- becomes abnormal and your choices change based on the relationship you have with yourself, the surgeon, and the team.

If for a second you make decisions based on your anticipated fear of failure- rejection- or down-the-line criticism, then you have failed- yourself, the team- and most importantly- the patient.

Failure to vocalize or communicate or take the initiative is a fatal flaw on many levels.

It means you shouldn’t be doing what you are doing in this profession.

It means you need to find a different line of work.

But in the short term- right in front of you- well you are probably going to hurt somebody- in a very serious way.

If it’s out of your control- that is one thing.

If you let it get out of control for whatever personal misgivings or insecurity-

well ADIOS cowboy.

=

This isn’t Sunday NFL. 

This is someone’s life in less time than it takes to “split to a commercial”.

Just a thought.