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Excerpts from: Heart Surgery in America: Perfusion Dreams

Editor’s Note:

This book is NOW over 99% written and moving into the Editing Phase!

The title of the book is “The Tips of Spears- An Inside Look At Heart Surgery in America”

It is a rendering of the reality, sometimes sad and at times funny, emotional, and clinical vignettes of the many different aspects relating to open heart surgery- from the perspective of a perfusionist. This book is a commentary not only on the intricacies of heart surgery, but openly engages and describes the peaks and valleys of ethical or moral successes and failures.  It highlights moments where lives are saved by the strength of the character of the team- as well as surgical strategies undone by flaws imbued in the highly trained individuals living and breathing this volatile work environment.

Here is an Excerpt from the book 🙂

Excerpts from: Heart Surgery in America: Perfusion Dreams


As a locums, the need to get on your feet quickly, assess your surroundings, and deliver a solid performance when called to do so is absolutely paramount.  Obviously, that implies that you have to get to know your environment very quickly.  I do this automatically now, having traveled so much during my professional career, but it does hover as a hurdle to be overcome, and impacts me the most when I sleep.  I have perfusion dreams.


Have you ever had a work-related dream?  You know, the kind where you are in it, working through a perfusion problem or cascades of problems?  I have always wondered about dreams like that. Obviously never had any before getting into the field, but then every once in a while, one would pop up so to speak.  At first, I thought it was a direct reflection of the day’s events, but I could have days with really tough cases, sleep like a baby with not a trace or correlation with whatever I remembered upon waking and revisiting the previous night’s ethereal slide show.  I must say in terms of perfusion related dreams- I have covered the gambit, draining reservoirs, cracked arterial filters, gas and foam in the arterial line, etc.

The most recurrent theme however, is where I find myself in an O.R., setting up for a case, and leaving the room for a second, and constantly being sidetracked by people or things encountered in unfamiliar hospital corridors, looking to find my way back to the O.R. because I know we are taking down the internal mammary artery, and that we will be passing up lines shortly, but the circuit isn’t primed, and we need to go on bypass, and I can’t for some reason find my way back, and sometimes I am not even in the building anymore, but some parking garage somewhere looking for the right entrance to the hospital, which once I find it, doesn’t even look the same- and I still can’t find the O.R.

And no… I’m not crazy, and yes I am confidant as a perfusionist. I respect the potential for the unexpected in our field, and no doubt recognizing that such an array of potential, unforeseeable cascading permutations are available on the whimsical wings of fate- well that probably lends salt to a work-related dream now and then.

So, what does it mean?  I have no Idea.  I Looked up dream theory, Freud, analysis, and stress related dreaming, and couldn’t come up with anything that directly addressed recurring dreams, about work, that are experienced by healthcare professionals in high stress jobs.  I’m sure there is literature out there, but this is more of a lingering curiosity rather than an immediate inquisition for a therapeutic diagnosis.  It’s not like a flurry of recurring dreams, rather just the incidental and unexpected from-nowhere re-visitation of my profession’s clinical arena.  I figure these to be not-so-subconscious fears of not being adequately prepared, or perhaps worrying about having missed something. That would seem to be an appropriate concern and is legitimized by the fact that we have perfusion checklists.  The morass of unknown and unfamiliar hospital hallways most likely a reflection of the challenges of having gone to so many different hospitals (back in the perfusion contract and locums days) where the first thing to overcome was an new clinical environment, and new cast of characters / personalities, and then immediately going on bypass.

When we dream- “perfusion dreams” I think it is a subconscious attempt to deal with latent or buried (perhaps unrecognized) insecurities or issues we have in front of us.

The fear of losing my way is one I encounter (albeit infrequently) and represents one of the few things that seem to nag at me at night.  Getting lost in an OR and not being able to find my way to the target (as in the CABG I am about to engage in)- at the new place I just arrived to.

This happens to be a recurring dream I have had over my career as a perfusionist- this tepid insecurity where I find myself in a room- with a pump unprimed, surgeon taking down the mammary- and man, we are going to be on bypass pretty quick- and I still need to prime.  So…. I have to assume that the dream is a coping mechanism for stress related to this occupation.


A significant portion of the dream elaborates on me having to leave the room to gather the things I need- and all of a sudden, when I turn back- after walking out of the main OR, I find myself in the middle of what appears to be a modern thoroughfare of a medical complex- with miles of corridors, restaurants and other Mall-like businesses, and an array of indistinguishable doors to open.  Of course- as I open the door, it becomes the wrong door- I recognize myself to be lost and unable to retrace my steps- throughout which- the entire time I am seriously worried about getting this system primed on time and be ready to go on bypass…

Then I wake up  (Bottom line?  It’s a dream and not reality- but it does make you focus on areas in your practice that may need refreshing- or you need to at least ask yourself the question of “why it bothers you to begin with?”).

Fast forward to today, at a new cardiac Mecca- somewhere in the Midwest, and no kidding- this OR has more twists and turns than any I have seen before- not to mention the fact that I have a drill sergeant for a mentor- (1 year out- but really pretty damn good and we enjoy each other’s humor) who is a stickler for decimal points and lot numbers, and probably finds it humorous that I appear to be on the edge of cluelessness regarding my own personal location in the space time continuum that represents my new life at this unfamiliar clinical site.

In the back of my head- I have to at least applaud his perspective and I hope it doesn’t skew the perception of my clinical skill level- as the two paradigms-(being lost in a new environment versus conducting a bypass run) are two distinctly different animals.


Oh well- repetition seems to be working- and am seeing a dramatic reduction in the amount of time it takes to get from the front door- to the surgical team.  It is however a valuable lesson relearned.

Another challenge met …  CHECK!

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