The 10-Minute Interview with Chuck Williams, BS, RPA, RA (CBRPA), RT(R)(CV)(CI), RCIS, CPFT, CCT, Atlanta, Georgia

I completed training as a radiologic technologist in the Program of Radiologic Technology, Washington Hospital, Washington, Pennsylvania and in the Program of Radiologic Technology, United States Air Force, Homestead, Florida, in 1966 and 1968, respectively. Although my first experiences in cardiovascular imaging occurred during my training phases, my introduction into invasive cardiology studies happened in 1974, when I accepted employment as a special procedures radiologic technologist with the University of Miami/Jackson Memorial Center, Miami, Florida. I completed two Bachelor of Science Degrees in advanced radiologic science at Weber State University in 2004. Currently, I function as a Cardiovascular Specialist III at Emory University Hospital Cardiovascular Laboratory in Atlanta, Georgia. Why did you choose to work in the invasive cardiology field? During my clinical training in cardiovascular studies at the University of Miami/Jackson Memorial Medical between 1974 and 1976, I was required to rotate weekly between special procedures in radiology and the cardiac catheterization laboratory. Although I found the procedures performed by radiologists to be outstanding emotional and mental enhancements, cath lab procedures required the knowledgeable use of blood gas analyzers, Douglas air bags, E for M (Electronics for Medicine) DR 12 and DR-16 hemodynamic and physiological monitors, film processing, temporary pacemakers, and especially, Friday afternoon conferences, etc. My preceptors in the cath lab settings were Francisco Montes-Garcia and William Embil. When other peers ask who taught me about the clinical and technical aspects in the cath lab, I answer, The boys from Havana, Cuba. I was taught how to derive hemodynamic data into cardiac calculations in Old Spanish. When I expressed a sincere desire to learn more, then both educators instructed me further in English. These men remain two of my most important mentors. I miss Francisco (Frank), whose untimely passing away occurred in October 1989. Recently, I thanked Bill for contributing to my career as a registered cardiovascular invasive specialist. During our short conversation, he assigned me another project - how to calculate stenotic aortic valve areas by correlating the LV pressure against the EKG waveforms. Although Frank has passed on, Frank and Bill continue to motivate me to focus on matching outstanding knowledge with quality patient care. Can you describe your role in the CV lab? I have been with the Emory Healthcare Organization since 1992. My current position is Cardiovascular Specialist III and my current duty station is the Cardiovascular Lab in our parent facility, Emory University Hospital. The job requires that I have knowledge of every invasive and interventional device used to help cardiologists complete the procedures on their patients. In addition, I regularly undergo required training on the use of clinical investigative devices. Most recently, I assisted a cardiologist with placement of the first FDA-approved carotid stents in Georgia. Along with the direct scrub assistant position, I operate the physiological monitors and administer moderate conscious sedation under the direct supervision of our physicians. What is the biggest challenge you see regarding your role in the CV lab? There are two challenges that affect how I function. The first challenge that affects my role in our CV \lab is procurement of men and women who are certified and/or licensed allied health workers, but have never been employed in a cath lab. My employer only hires employees who have their basic certifications and/or licenses such as registered nurse, registered radiologic technologist in radiography, registered cardiovascular imaging specialist, etc. Nurses are required to have critical care experience. The second challenge pertains to new, inexperienced employees, who are recommended by our human resources department and hired by our managers. When these inexperienced cath lab employees report for preceptive guidance, they lack knowledge of circulatory anatomy, moderate conscious sedation, and physiological monitoring and technical skills. What motivates you to continue working in the CV lab? I am triggered by a daily desire to provide quality patient care through my abilities to function professionally and technically as a multi-certified allied health professional who has been educated and trained to be one of the best technologists in the field. In 1987, I came close to leaving the field. However, during this time, I met an orthopedic surgeon, Dr. Robert Miller, for dinner. This outstanding late physician, who suggested and helped create the first paramedic program in the United States, told me that I was trained by some of the best cardiovascular medical professionals in the world and that my job was to continue to pass on what they gave to me so freely, because they believed in me as one of their peers. Another important educator told me that if I ever reach a point where I feel I can no longer care for a patient, I am to leave the field immediately. In 1987, thanks to Dr. Miller, I had a moment of clarification that motivated me to continue my work, pass onto others what I was freely given by many of the pioneers in the field of cardiovascular imaging, and most of all, to provide the level of care I would expect if I was being placed on the procedure table. When I was in the first two years of training as a radiographer, Dr. Edward Turich, who was one of my mentors, always conveyed one message to me. His message was, You always treat a patient as if you are the one on the procedure table, because one day you may be the patient. I am very grateful that I continue to cross paths with peers such as Craig Cummings, Marsha Holton, Ken Gorski and Dick Stueve, because we all have had a long tenure in the field and their enthusiasm and merriment continue to enhance my career. In the Emory cath lab settings, the physicians who help to maintain my motivation are Drs. Wendy Book, Stephen Clements, Jr., J. Willis Hurst, Brenda Holt, Henry Liberman, Jerre Lutz, Gerald McGorisk, Douglas C. Morris, Andrew Smith, and Dr. John Douglas, Jr. In 1998, I transferred to our main hospital to work beside Dr. Douglas, who is and remains a modern pioneer in interventional cardiology. One important factor that I have learned from these physicians is the pride they display when they care for their patients and their families with the highest degree of compassion and kindness, without unveiling their tiredness from the hours they work. My motivation and enthusiasm initiates from my interactions with my peers, my patients, and their families. My enlightenment as a cardiovascular invasive specialist is achieved from the lore given me by my patients and their families. If anyone anywhere reaches out for help, I need to be present to assist those who come to our cath labs electively or emergently with histories of angina. What is the most bizarre case you have ever been involved with? Although I have experienced many such cases, the most bizarre case involved a patient who had had an angioplasty of the RPDA (right posterior descending artery). She was administered abciximab. During the course of the procedure, a tiny twig was perforated. A POBA (plain old balloon angioplasty) was done across the larger segment of the artery with the hope that hemostasis would occur. After a length of time, the vessel appeared to have sealed. The patient was then taken to a critical care unit. In the early evening, the call team was summoned to return because this woman was developing cardiac tamponade. She was rushed to the cath lab. The vessel had reopened with pericardial tamponade in tow. Her vital signs were deteriorating. A pericardiocentesis was performed and blood was emptied as quickly as the artery was hemorrhaging. Several units of blood and platelets were administered. The large segment of the artery was occluded with a small angioplasty balloon. When the balloon was deflated to check status, angiograms showed more hemorrhage. After three and half hours, the cardiologist, who tried everything to save this woman's life, asked the circulator to clean the plug on the bag of platelets and to draw 10 ml of platelets with sterile technique. The nurse injected the platelets in a syringe for the cardiologist in a very sterile fashion. The balloon was deflated for a few seconds and moved back a few millimeters. The cardiologist removed the angioplasty guide wire from the balloon and injected the platelets into the small branches of the distal RPDA. The artery sealed and remained sealed after an hour. The patient was transferred to her critical care bed. A few days later, she came to the cath lab to thank the cardiac team who cared for her. Interestingly, the reason she came to the hospital was that her son had awakened that morning with angina. While she was graciously expressing her gratitude for her care, the cardiac team performed a cardiac cath on her son. When work gets stressful and you experience low moments (as we all do), what do you do to help keep your morale high? When I have stressful moments, I focus on my spiritual well-being. My inner strength comes from a Power greater than myself. As soon as I can detach from the situation, I always take a short walk away from the area for 3 to 5 minutes. If it is lunchtime, I always take a the walk outside so I get some fresh air. During the 3-5 minute walk, I review the experience or experiences that triggered the added stress. If the causes are beyond my grasp, then I let it go. If I have caused the added stress, then I examine the cause and work on an immediate resolution. Once I have taken the appropriate action within myself, I immediately focus on the solution, not the problem. I attempt to match calamity with serenity. The quality of care that I provide to my patients parallels my spiritual, emotional, mental, and physical well-being. If any stress factor is not relieved immediately, I contact one of my mentors and discuss the elements of the stressful situation with the hope they can pinpoint what I may have overlooked about the situation that triggered the energy-depleting moment. My vexation most strongly occurs when a patient expires during a procedure. Luckily, I have only witnessed 28 deaths since 1964. Are you involved with the SICP or other cardiovascular societies? I am currently a member of the National Society of Radiology Practitioner Assistants (NSRPA). This society has several members who are employed in cath labs across the nation. I am currently a member of the Executive Advisory Committee for the Certification Board of Radiology Practitioner Assistants (CBRPA). Between 1997 and 2003, I served on the Cardiovascular Interventional and Cardiac-Interventional Examination Committees with the American Registry of Radiologic Technologists. I will soon be a member with the SICP with plans to apply for a faculty position with the SICP. Are there websites or texts that you would recommend to other CV labs? I would recommend the following texts (see sidebar) be considered for the CV lab. The websites are just suggestions that can lead any nurse or technologist to thousands of other websites. (See Sidebars). Do you remember participating in your first invasive procedure? I assisted on my first carotid arteriogram on April 15, 1965. A general surgeon performed the procedure, while the medical director of radiology attempted to film the contrast media filling the right common carotid artery with a standard fluoroscopic film spot device that could make four images over a minute. The artery was fluoroscopically viewed on one of the early image intensifiers. Neither physician had ever performed a selected carotid arteriogram, nor, to the best of my knowledge, did either attempt it again. I still do not know why the physicians did not use the Sanchez-Perez cassette changer for imaging of the carotid. Fellowships in invasive cardiovascular procedures were in their infancies. in the 1960's. Recently, I spoke with the neurosurgeon, Dr. Robert Tolmach, who performed the first carotid arteriogram in 1949 in Houston, Texas. This retired surgeon general and lifelong mentor introduced needles directly into the common carotid arteries. What I did know was that I was determined to become an expert on the human circulatory system from an angiographic standpoint. Any experienced technologist can determine my feelings after that exciting moment that would highlight any student's training program. In early 1982, I visited Emory University Hospital so I could gain knowledge about angioplasty through an invitation by another cardiovascular invasive specialist, Joe Brown. This peer was kind enough to invite me to the Emory facility, where interventional cardiology became a new entity in 1980 and history occurred. On April 12, 1982, the first PTCA of a RCA was performed at Mercy Hospital, Charlotte, NC. I assisted a very experienced invasive cardiologist, Joel Webster, with our first angioplasty. We knew we were entering into a new tier of our careers. The patient did well and the images were successfully recorded on 35 mm cine film. I feel fortunate to have experienced many milestones in my career. If you could send a message back to yourself at the beginning of your CV lab career, what advice would you give? There are several messages that I have used daily throughout my career. All were statements of motivation given to me by a few mentors that have been part of my career over the past four decades: Find training in the health industry because people deal with illnesses. They will need medical care and you will always be employed. Virgin Williams, my father, 1964. Be kind to all people, including those come from environmental services to clean our offices, for we may have to ask one of these men or women for a simple solution to a problem we are not able to resolve with our educated and complicated minds. Dr. Manuel Viamonte, Jr., Professor in Radiology, 1974. If you do not choose management as a pathway, study and work hard to gain the knowledge and experience in many areas of the allied health industry. Travel horizontally, because medical imaging will change rapidly over the next several years. Never curtail learning. When the changes come, you will always have a job. Dr. Manuel Viamonte, Jr., Professor in Radiology, 1974. We all function as team. If you are in my OR and I ask the circulating nurse to tell you to go to the scrub sink and scrub, I expect you to do what is asked. If I am in your procedure room and you ask me to do the same, I will do what I am asked. Only you will determine how long you want to be part of our cardiovascular team. Dr. Robert Zeppa, Professor in Surgery, 1974. Never place the cart in front of the horse. Dr. Melvin Judkins, 1974. Do you know what efficiency and proficiency means? Efficiency is being very good at what you do and proficiency is when you become so good at what you do, your peers can not see the mistakes you make. Dr. James R. LePage, Emeritus Professor in Radiology, 1975. Can I ask a question, who taught you to use catheters and to perform angiography? Harvey Koolpe, Interventional Radiologist, 1978. Dr. Melvin Judkins : Critique this image. After several neophyte cath lab personnel and physicians discussed the quality of the LCA during one of the technical sessions of the SCA & I meeting in 1982, Professor Judkins then grinned and said, This is a photograph of lightning over the Pacific Ocean. His next slide was of a cart attached to the front of the horse. When you go to work every day, tell yourself to do what needs done and not what is required. Do not expect anything in return, including your paycheck. Carol Gaines, 1988. You have been trained to be one of the best in your field by some of the best educators in world. Pass your knowledge on freely just as it has been given to you, so others who want to follow in your footsteps can do so with the dignity and pride exhibited by you to your patients and your peers. Dr. Robert Miller, Orthopedic Surgeon, 1989. Always remember the mind deals with yesterday and tomorrow. The brain deals with now. Whatever happened yesterday is gone. Whatever happens tomorrow cannot occur until it becomes today. We cannot project into the future. Therefore, we must deal with the moment, which is now. Author unknown, 1988. Why do you have to be so damn efficient. Dr. John S. Douglas, Jr., Professor in Medicine and Cardiology, 1999. Where do you hope to be in your career when it is time to retire? In 2001, I returned to college to embark on a new career field that was started through the suggestion of a United States Army radiologists, Colonel Sankaran S. Babu and Lt Colonel Gregory N. Bender, who brought their conception to Weber State University, Ogden, Utah. They created an idea that became a reality when they coined the name of a new imaging field, Radiology Practitioner Assistant (RPA). Their idea was to find a way to train radiologic technologists to perform procedures and to do basic interpretation of the images. This year, I completed two Bachelor of Science degrees with majors in Radiology Practitioner Assistant and Cardiovascular-Interventional Technology (CVIT). In addition, I have completed all of the course requirements for a master's degree. I have two goals left to complete prior to retirement. One is find a teaching position so I can give back my knowledge of cardiovascular imaging to those who wish to follow the old-timers in a field that has provided me with so much happiness and joy for two scores. The second goal is encourage Weber State University to modify the RPA curriculum to include Registered Cardiovascular Invasive Specialists (RCIS), certified through Cardiovascular Credentialing Incorporated (CCI), into a cardiovascular subspecialty pathway. The seed was planted two years ago. After retirement, I may obtain a teacher's certificate, so I can teach high school classes in a local facility wherever I reside. Has anyone in particular been helpful to your growth as a cardiovascular professional? Throughout this interview, I have mentioned a few of those men and women, who molded me into the caliber of cardiovascular imaging specialist I am today. If I only commended one person, I would negate my gratitude for the remainder of my peers. I have walked beside many outstanding men and women while they conveyed their knowledge, in order to gain wisdom. They are: James Abraham RPA-RA, Dr. Akele Aluko, Dr. Homayoun Amin, Dan Anderson, MS, Susan Anderson-Glover RN, Dr. Will Anderson, Dr. Scott Andrews, Betty Ashdown RCIS RT, Dr. Jeffrey Augustine, Dr. Vasilis Babaliaros, Sharon Ball, RT, Dr. Carl Balli, Dr. Frank Barham, Dr. Jim Barnhill, Dr. Maury Baron, Dr. Louis Battey, Cathy Bauch RT, Leann Bauch RN, Dr. Deborah Baumgarten, David Bergeron RT, Lynn Bettis-Tobin RN, Debra Bittrick RN, Dr. Peter Block, Dr. Erik Boijsen, Dr. Hooshang Bolooki, Dr. Wendy Book, Jerry Borgert, Peggy Boyd RT, Omar Bradley, USA General Ret, Joe Brown, RCIS, Byron Bullard, Dr. Bill Bullock, Eric Burd RPA-RA, Laura Burhans RN, Tom Burke RT, Darrell Bush CVT EMT-P, Jerri Byers BS, Scott Cameron, RCIS, Norris Camp, Kathy Canfield RT, Dr. Quinn Capers, Tom Caponi, Dr. Walt Carpenter, Barbara Carter RN, Dr. Augustino Castellanos Sr., Dr. Chrisopher Cates, Dr. Mike Cecil, Josh Chandler, Karen Chandler RN, Dr. William Cheek, Dr. Richard Chen, Dr. Joe Civetta, David Clapp RT, Dr. Stephen Clements, Jim Colgate CVT EMT-P, Stephanie Collins RN, Dr. Richard Colvin, Dr. Nelson Courtney, Robert Culverwell, Craig Cummings, RCIS, Ginny Cunningham RT, Dr. Joe Davis, Dr. David DeLurgio, Dr Steve Dempsey, Dr. Barry Dix, Emma Dollar, Dr. John Douglas Jr., Joy Eder, Dr. Chuck Edwards, William Embil, CVT, Dr. Durval Ferrante, Mike Foster, Dr. Robert Franch, Pattie Freschett RN, Marsha Frye RT, Ivan Gambrill, Dr. Samer Garas, Dr. Otto Garcia, Dr. Ali Ghahramani, Kathy Groce RN, David Guidas RT, Lanier Lake Hall RT, Rhoda Hammer RN RCIS, Dr. Mark Hanson, Linda Hardwick RN, Wynn Harrison RT, Donna Hart, Lorena Hendry PA, Kathe Holmes RT, Marsha Holton RN RCIS, Neil Holtz CVT EMT-P, David House, Jerry Honeycutt, Dr.Terry Hudson, Jeff Huff RT, Donna Hunt CVT, Jay Hunter USAF CMSgt Ret, Dr. Kim Hyatt, Pamela Hyde RN, Tammy Jenkins RN, Karen Jesse-Caponi, Joy Eder, Kathe Holmes RT, Joseph Chip Johnston RT, Anita Jones RT, Alberta Jovi RT, Dr. Melvin Judkins, Dr. Anna Kalynych, Dr. John Kathe, Cathy Kavanaugh RN, Dr. Diane Kawamura, Dr. Spencer King, Lynn Kirby RT, Valerie Kiser RT, Melana Klukewich, Dr. Deventra Koganti, Dr. Harvey Koolpe, Dr. Louis Koolpe, Mary Lama RT, Kathy Landress RN, Dr. Jonathon Langberg, Dr. Sonya Lefever, Dr. Angel Leon, Dr. Jim Le Page, Sharon Lewis RCIS, Dr. Henry Liberman, Rene Lopez RT, Christine Lucas RN, Dr. Anders Lunderquist, Dr. Jerre Lutz, Dr. Stephen Mallon, Dr. Tift Mann, Dr Steve Manuokian, Dr. Luis Martinez, Susan Mayer RN RT, James Mazeruk, Ron Mazeruk, Coleen McElroy RCIS, Harvey McKinley RCIS, Dr. Jonathon McLean, Loretta Medency, Dr. Fernando Mera, Dr. Chloe Merrill, Dr. Chris Merritt, Dr. Robert Miller, Francisco Frank Montes-Garcia CVT, Dr. Robert Moore, Dr. Douglas Morris, Dr. Fred Murphy, Tricia Neal-Gray RT, Diane Newham RT, Dr. Gary Niess, Richard M. Nixon, Dana Nossett RT, Bhawna Oberoi RPA-RA, Dr. Olle Ollson, Michele Parsons RN, Marsha Pattison RT, Joe Phelan, Sarah Poe CVT, Dr. Ed Proctor, Jim Quigley RT, Kevin Quinn RPA-RA, Sheila Quinn RN, Dr. Gerald Rapp, Dr. Mark Raymond, Judy Ridge RT, Steve Robb, Dr. Bill Roberts, R. Bruce Robertson MS, Pamela Ross RT, Dr. Ed Russell, Tracy Schneider NP, Charles Ruble RT, Dr David Schultz, Linda Seyl RT, Dr. Earl Shirey, Dr. Bill Small, Dr. John Smith, Dr. George Soliman, Dr. Leonard Sommers, Dr. F. Mason Sones, Dr. William Sprunt, Susan Steinbis NP, Dr. Mark Steiner, Pattie Stephenson RN, Dick Stueve RT, Linda Syels RT, Dr. Stefan Tigges, Robert Tolmach USA Brig Gen Ret, Dr. Ajay Tuli, Dr. Ed Turich, Corey Tyler RT, Dr Richard Ulibarri, Joe Ungaro RT, Dr. Jane Van Valkenburg, Dr. Bob Vandenberry, Helen Vargo, Dr. Manuel Viamonte Jr, Dr. Robert Vincent, Donald Vivian USAF Lt Gen Ret., Dr. Robert Walker, Terri Walsh RT, Dr. Joel Webster, Dr. Kenneth KD Weeks, Thomas Whitmore, Mary Jo Whitton CVT, Shannon Whitton NP, Virgin Williams, Bess Williams, Bernard Williams RT, Charles L Williams, Donald Williams, Jarrod Williams BA, Kristen Williams RT, Ronald Williams RT, George Wilson, Chalmers Wise, Jerry Wise, Pat Wise and Harry Wylie. I was given a very important suggestion by one of these mentors, Dr Manuel Viamonte, Jr. in 1974, when I chose to make cardiovascular imaging my career. He said, Let your peers build you. If you do, you will be successful and you will be respected and admired as an expert in the field of cardiovascular imaging. If you try to build yourself, you will fail and will lose the respect of the peers that tried to build you. This physician has remained a part of my career. In conclusion, if I could say that one person helped put me where I have been and where I am now as a cardiovascular invasive specialist, it would be Dr. Viamonte, because he opened the door on a career that has taken me on a journey that is beyond the average cardiovascular invasive specialist's imagination. One other person who helped open another door for me was Melana Klukewich, who inspired me to enjoy writing. And finally, I am eternally grateful for each and every one of my mentors, because they continue to open the other doors to other horizons in daily aspects of my career. Where do you think the invasive cardiology field is headed in the future? I have observed the evolution of the technical aspects of cardiovascular studies from diagnostic studies into interventional procedures. I am very grateful that I have been part of the evolution of interventional cardiology and interventional radiology, which includes the peripheral theater. My career has been an embarkation into new aspects of the daily advancements and improvements in instrumentation that has enhanced management of patients suffering from cardiovascular disease. I hope that the population of North America witnesses the birth of an emergency program that will classify the severity of acute heart disease into a structure similar to the guidelines for acute trauma in our communities in the next decade. If the classification is approved by our federal and state governmental bodies, patients experiencing acute life-threatening myocardial infarctions could be transported directly from the field to hospitals that can offer emergent coronary intervention instead of being sent to the most immediate facility or the a facility chosen by the patient, where only diagnostic-only studies are performed. Our cardiologists, cardiac surgeons, internists, and cardiovascular allied health workers should take an interest and help their communities lobby their state government officials along with their federal counterparts to create the bills that would create such a program. If it became a reality, more heart victims would survive their heart attacks and would enjoy a more pleasurable life with less myocardial damage. If this structure becomes a reality, patient morbidity and mortality would sharply decrease. Futuristically, I entertain the view that percutaneous valve replacements will become a routine procedure in the tertiary level facilities and stents will continue to improve, so that in-stent restenosis becomes minimal. In addition, gene research may permit our physicians to establish medical regimens that reduce the advancement of atherosclerosis in patients at an earlier stage of life. Furthermore, I foresee the movement of nurse practitioners (NP), physician assistants (PA), radiology assistants (RA), and radiology practitioner assistants (RPA) into a more active role in our procedure rooms, which includes performing procedures under direct physician supervision. SICP

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