My Perfusion Job Shadowing Experience: Day 1

(Reprint 2014)

Editor’s Note:

This is part 1 of what is going to be a 3-part series- the first two posts presented by a young, soon-to-be medical professional who job shadowed for two days with me.  The last will be a re-post of something I had written- that reflects the difficulty of the case we shared and encountered.

He is soon to graduate from a very prestigious university here in Texas, and has more than established his unwavering commitment to medicine and human welfare- not only with a clearly direct and dedicated effort during the process of job shadowing- but prior to this- committing himself to a medical mission to the Republic of the Philippines, and spending time there with an anesthesiologist I truly admire.

My own experience as a Hospital Corpsman, in the United States Navy included a 15 month stint working in an emergency room of a very significant Naval Base in Subic Bay, Republic of the Philippines.

So I had a pretty good idea of what he and the Mission had to go through to accomplish their humanitarian effort.  Outwardly friendly, yet many political and local agendas that need to be incisively negotiated.  

Uncertain surf so to speak.

My Perfusion Job Shadowing Experience:  Day 1

I am a nutritional science major about to enter my last year of undergrad.  I have found a passion in medicine since I was in high school. Before I start I would like to apologize if this might be a rather boring read. I have had to write various and boring research papers during my time in undergrad, but I am very excited to share this experience so buckle up.

I first learned about the career of perfusion through a good friend of mine’s father who practices in my hometown. After doing research on the career and seeing how great of an impact they can make on peoples lives, I decided this was a field that would be perfect for me. I had never experienced seeing a perfusionist in action and wanted to see exactly what I was getting into before investing my passions, time, and money.

I called up Dr. Greg Miller an anesthesiologist from Lubbock Texas, whom I had the pleasure of going on a medical mission trip with. He called up Frank Aprile CCP, a perfusionist that practices in his hospital. After I got his number I called him up and introduced myself. He greeted me with jokes and was very willing to help me out. He introduced me to the CircuitSurfers.com perfusion website and told me to use this as a resource to learn more about profession. I kept in touch with him until we found a time for me to come see him in action. I was told he would challenge me and ask me difficult questions while I hung out with him. This was exactly what I wanted to hear.  I had no idea how much I was actually going to learn.

Knowledge is power

I thought I would prepare myself for shadowing by looking at different articles on Circuit Surfers. I was amazed to see how hard this field really is! I knew there would be a lot of pressure when I started to look into it but you have to be a certain type of person when getting into this field. Not only do you need to know the physiology and anatomy of the body, but you also need to be a mechanic with the machine. You have to be able to make quick decisions and be confident with every one or you could lose the patient. This was great for me to be exposed to because I had to really look at myself and honestly discern if I had ice in my veins.

FIRST DAY OF EXPOSURE

I finished my last final for my summer classes and started the long eight hour journey to Lubbock Texas. I got into town around 2am and was relieved to find out that my day would start at 9am giving me some much needed shut eye. I arrived at the hospital and was greeted by Mr. Aprile, I cannot tell you how excited I was to learn more about what he did. We went up to the ICU  after he got me some very stylish and baggy scrubs to wear. I immediately could see how good his relationship was with everyone else on staff there. That was the first lesson he taught me, always maintain good relationships with your coworkers. These people are going to go through hell and back with you to save lives and it is important they trust you, not only on a professional level, but as your friend as well. I was also introduced to the ECMO machine, this provides cardiac and respiratory support to the patient when damage or disease has inhibited their natural functions. It is the job of the perfusionist to provide 24/7 monitor and care while the patient is on it.

After we toured the ICU, we then traveled over to the main hospital where surgeries are taking place. It was here where I was first exposed to a confusing alien apparatus of various tubes and monitors known as the cardio pulmonary bypass machine. I was almost intimidated by it when I first saw it. This machine looked very confusing to me, but Mr. Aprile was very knowledgeable and knew it like the back of his hand. He taught me how it worked and I learned where the venous and arteriole flow started and ended, all the while he asked me questions on how much I really knew about the cardiovascular system. After taking anatomy at a prestigious university I came in there assuming that I had a pretty good idea how every thing worked, I was very wrong. Mr. Aprile was very knowledgeable on how the cardiovascular system worked. Perfusionist are responsible for so many things and having as much knowledge as you can about the body is very key to becoming successful at your job. Making this knowledge second nature to you will allow you to be able to troubleshoot any issues that may occur during a case. Mr. Aprile showed me the different drugs that he is responsible for administering to the patient during a case and how they effect the body. Drugs like potassium, which is used to stop the heart, can be very dangerous if you don’t administer it at the right time and with the right amount.

I could not tell you how intimidating it was when I was first learning about what all is involved with profession. Mr. Aprile was flawless when explaining things to me and taught me the most important thing is not to have tunnel vision when presented with a problem during a case. This lesson is invaluable because so many different things could go wrong whether it be mechanical or an error that you have done. The problem could be a simple kink in one of the hoses or something even more serious like a malfunctioning part. Knowing how to find the problem and fixing it in seconds could ultimately decide the fate of the patient, and if you panic you will fail.

Preparation is Key

Extensive preparation goes into each case to prevent any issues from happening. We checked everything on the machine and then went into his office to go over paper work for the case he had the next day. He looked over the double, possible triple, valve replacement that he had to insure he knew what to prepare for. We filled out paperwork for the patient and he explained the mechanism that could cause problems with these valves. Did I mention how knowledgeable he was? He really impressed me on how well he was able to explain things to me to a degree that I could understand. The first day was in the books and I was then going to have my first exposure to a live case the next day. I ended the day mentally drained by all the information I was given, but ecstatic to see more. I never would have guessed the pressure perfusionists put themselves through every day. That being said, I was so excited to see this. I wanted to be challenged and be put in high stressful situations that are different each day. This is what made me passionate for medicine. If I wanted an easy low stress job I would not be looking in this field, I crave to have that pressure and after that day I was craving for more exposure and knowledge.

When I went home that day I immediately got on my computer and looked up more about how heart failure occurs, and how your body is effected by elevated calcium levels in the system. I couldn’t look at it enough but knowing that I had to be up at the hospital at 5:30 am I turned in early so I could be fully prepared for the next day when I would see Mr. Aprile in action.