EXCERPTS FROM THE RED CELL HIGHWAY: Forged By Fire

Editor’s Note:

This book is NOW over halfway written,

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 🙂

Tampa

Tampa Florida and the front half of my 20s were the perfect mixing pot of new and rigorous training, combined with a lessening gentle peeling away of the grand façade that medicine had represented to me up until this point. Although I was no longer a novice, there was a certain majesty and mystical quality to the medical profession, a certain spiritual/divine authority that I ascribed to the physicians that I had encountered so far during my career in the Navy. Doctors were still to be revered, the trappings of demigod were a little looser fitting now, and the fabric showed frays on the edges that I never noticed before. The perfection that was medicine may have become slightly imperfect based on my observations and what I gleaned during my two years in Florida. My idols (doctors) while at one point in my life where the ultimate expression of academic success and achievement, were slowly becoming less mysterious, less untouchable and less-than-perfect. That’s not to say that the physicians I encountered and worked with, that trained me, and that pushed me, were flawed in any way – but the implication was there and the writing was on the wall that just like every piece of mountain crystal, if you look close enough there will be minute cracks and flaws. I think my mother, set me up for that. She touted her PhD like a Valkyrie wields her sword with an air of invincibility that suggested a complete and total denial to the concept of failure or mortality. It was her reverence for the title M.D that for me represented a cloak of spiritual ascension and an almost mystical plateau unreachable to most mortal men. As a child they were gods to me, as a young man they unraveled themselves to reveal the essence of academic achievement intertwined with the strengths and weaknesses that all of us possess. The degree itself I fully respect and found to be quite laudable, but just like any other tool it is worthless if employed by the unskilled, the uncaring, or the righteously arrogant. The bottom line? The two years in Tampa taught me that simply possessing the degree did not confer the level of talent associated with the greats, beginning with Hippocrates.

 

Forged By Fire

Having worked as a surgical technologist and as a surgical first assistant starting from the age of 22 until I turned 28 I developed a lot of skills that in hindsight, prepared me well, for my career as a cardiovascular perfusionist. Clearly, manual dexterity is part of the skill set required to be an effective and proactive surgical first assistant. I acquired that skill during my tenure in Tampa at the University Community Hospital where I basically cut my teeth in regards to becoming familiar with all aspects associated with vascular surgery, developing both speed and quick hands. As well, surgeons relied on us heavily in order to ensure the proper positioning was effected, that all and any specialty items required for a particular operation were readily available (this was before preop timeouts), and depending on the relationship and trust level that you have established with a particular surgeon you are assisting on any given case, they might lean on you to truly engage in the more subtle aspects associated with first assisting. Cutting, tying, and sewing are a given when it comes to first assisting. The point where you transition from technician to artist is when you are able to anticipate the upcoming needs that the surgeon will have during the operation and proactively assist as opposed to reacting to a verbal command or the next surgical road sign.  In the OR, it’s always about getting from point A to point B, but sometimes there are construction detours or delays for whatever reason(s).

These same attributes are prerequisite for the conduct of cardiovascular perfusion. As a perfusionist, you must always be aware of not only the operation and where you are at now, but you also should know where it is you are heading. The need for speed is essential and I developed that trait during my tenure as a first assistant.  Being on call necessitates the ability to wake up and go from 0 to 60 mph in a heartbeat (no pun intended) and gather your wits about you, a quality that is prerequisite and consistent with the field perfusion as well. A key quality that I developed while assisting during surgeries and emergencies, was the ability to think globally and not get tunnel vision. Tunnel vision occurs under high stress situations where you react in a linear fashion to an unexpected and evolving potential disaster on the operating table. If you only see what’s in front of you, you become boxed in and are incapable of thinking outside of that cell inhibiting your decisiveness in in coming up with a solution that will both fix a problem that you’re dealing with, as well as not harm the patient. The ability to keep your thought process unconfined, allows you to see the problem from a global perspective thus affording you more alternative solutions to select from- or more importantly, doesn’t funnel you down into a tunnel that has no cheese.

Another significant trait garnered both from Navy medicine, in the emergency room while in the Philippines, as well as a scrub tech in the operating room theater, was repetitive organization and an OCD approach on how I organized my mayo tray when scrubbing in on a case, or how I set up the ECC for an upcoming or emergent pump run. The lesson learned here is always set up the exact same way, so that it becomes automatic as opposed to an active thought process which would take away my attention from other very important extraneous aspects of the operation I was about become part of, and the possible permutations that I would need to anticipate.

I was in a rut though, professionally thwarted by either lack of money, or a sense that my biological clock was going to “time me out” of higher academic arenas for the simple fact that things like med school would take another 12 years or so to finish- and age would become a factor.  It was time to choose- or maintain the status quo.

 

Truth be known?

I watched ONE open heart procedure before I selected my forgone conclusion.  It was that precise- and that simple.  One moment in time on some Summer afternoon in a San Diego Hospital- where I watched the crisp, fast, and methodical precision that the perfusionist demonstrated in terms of getting an emergent case on bypass.  Poetry in motion.  I thought I was good- but he was better.  I was an extreme competitor at that point in my life- so I respected the crystal clarity in the decision-making-process that the art of perfusion requires.  I t was obvious to me that the task at hand was an exponential leap in terms of patient responsibility.  I was going from assisting- to a paradigm that requires serious and legitimate confidence as well as a substantially scaled up command of physiology and understanding the amazingly complex variants that present when putting a patient on bypass.

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