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The 10-Minute Interview With Jason Money, RN, RCIS
Why did you choose to work in the invasive cardiology field?
I guess I would have to say the profession chose me, or another way to say it might be that I was "raised by wolves.” I grew up in the cath lab, and have gone from transporting patients at age 18 to developing entire educational programs in the same lab as a full-fledged professional. I have always had an affinity for radiology, and started out working weekends as a transporter/secretary during high school. At the time (1986-1990), the cath lab was still a part of radiology at my hospital in Springdale, Arkansas as it was in many other places as well. At the impressionable age of 18, I felt the cath lab crew at my hospital were the coolest guys around.
Can you describe your role in the CV lab?
As mentioned before, I have been honored twice with the position of Educator in cath labs, starting with my home lab in Springdale, AR and then again at Ascot Angiography in Auckland, New Zealand. I have worked as a traveler in several other labs where I alternated working at whatever skill or skills were required of me. I am equally comfortable at the hemodynamic monitor, in the nursing (circulator), and scrub role, as well as image processing.
What is the biggest challenge you see regarding your role in the CV lab?
As a traveler, adaptation is a constant test. It is not easy walking into an environment with its own roles, rules, and expectations. It takes a lot of humility to put yourself out on a limb with nothing but your skills and knowledge to keep you from falling. Even sound skills are not always enough in an emotional or politically charged environment. Adaptation is the key. One cannot act too smart while at the same time having to appear to be everything they expect out of this hotshot traveler from wherever, who probably thinks he’s better than us. I have been taught some hard lessons traveling and can’t say I am done learning. It is hard to realize that you will never be as good as those around since you are playing on someone else’s home field and you don’t have intimate knowledge of their procedure, doctor preference or hospital policy. Sometimes you have to play dumb and just do it their way as to not stir the water. This does take some pride-swallowing, since many labs think their way is the only way it’s ever been done. I love to teach, so education has been my salvation in this field. I am always enthusiastic about teaching others. This too can be tricky while traveling, as you don’t want to be seen as undermining existing power structures that are often built on withholding of knowledge. I would say the biggest challenge is not getting burnt out. Too many hours of work, topped off by trying to do everything the way it should be done, will do in even the most ardent professional over time. Dealing with travel companies also has its own bitter sting, as well as the constant challenge of motivating people to learn.
What motivates you to continue working in the CV lab?
I have not yet been able to say to myself, Well, you’ve finally reached the peak. You can’t learn any more or do things any better. More concrete, though, are those times when everything goes right, and you know that what you have done has truly affected someone else’s life whether it is a patient whose life has been saved or a glimmer in a student’s eye when they finally comprehend something they never thought they could.
What is the most bizarre case you have ever been involved with?
I was on my first travel assignment in a lab. We were called in on an acute myocardial infarction (AMI) case. It was a young male who had been found after falling out of a janitorial closet in the ER. He was defibrillated on the ER floor and subsequently found to have an ST-elevation MI. He was initially treated with IV nitro and heparin, and sent to us for a left heart catheterization (LHC) and intra-aortic balloon pump (IABP). He presented in cardiogenic shock and was found to have normal coronaries. We later determined that he was a janitor who was smoking cocaine in the closet, which induced coronary artery spasm, causing him to go into v-fib, fall against the door and out into view of the ER staff. In the end, the nitro (appropriate or not in cardiogenic shock without pressure support) had countered the spasm. He had an EF of less than 20%, but returned to almost normal function after eight weeks. He completed a rehabilitation program and was welcomed back to the hospital by understanding staff.
When work gets stressful and you experience low moments (as we all do), what do you do to help keep your morale high?
Reminding myself that we are here to do good work. The drama and politics may get in the way at times. The hours may be too long and the load too heavy, but what we do can really make a difference in someone's life. That difference can be good or bad equally, depending on how we represent ourselves.
Are you involved with the SICP or other cardiovascular societies?
I am not currently involved in any societies. I am a proud member of the Cath Lab Digest Consulting Editorial Board.
Are there websites or texts that you would recommend to other CV labs?
I think the www.theheart.org and www.tctmd.com are vital websites for keeping updated on the fast-changing world of cardiology. Dr. Morton J. Kern’s book, The Cardiac Catheterization Handbook (Mosby) has been a wonderful teaching tool and resource. Wes Todd’s study guide for the RCIS exam is excellent as well.
Do you remember participating in your first invasive procedure?
The first time I scrubbed in on a case, the doctor assured me everything would be just fine. The case progressed to an angioplasty and IABP insertion. The doctor basically did everything and carried me through the procedure. At the end, I remember saying, For all I know, we were working on this patient's brain. I knew then that I had a long way to go.
If you could send a message back to yourself at the beginning of your CV lab career, what advice would you give?
Work to live don’t live to work. Treat every patient like they were your own mother or father. It may not always be that simple, but it sure makes decision-making easier if you ask yourself, What would I do if this was my mom? I am not perfect and have had my weak moments but I do honestly try to keep the previously mentioned quote as a guide.
Where do you hope to be in your career when it is time to retire?
I really enjoy teaching and would look forward to continuing work similar to the teaching job I had at the University of Auckland in New Zealand. I was teaching ACLS and Airway Management to medical students and doctors as well as courses on teaching techniques to educators and preceptors. I found that the way to affect the most lives is actually to teach sound, fundamental, life-saving skills to those who come through the courses. In this way, you are sending out many more people armed with the knowledge and skills to save lives.
Has anyone in particular been helpful to you in your growth as a cardiovascular professional?
Dr. Charles Inlow paid for my LPN schooling so I could get to work in the cath lab, as well as supporting me as a mentor for many years. The staff of my original lab in Springdale, Arkansas, will always be like family, as we grew together in the field. I also have had wonderful support from the cardiovascular professionals in New Zealand.
Where do you think the invasive cardiology field is headed in the future?
I feel that we are really starting to get a grasp on treating ischemic coronary artery disease, and that the future will be devoted more to treatment of the vulnerable plaque and prevention of acute coronary syndromes (ACS). I think that CT and MRI will begin doing more diagnostic work, and that we may see a day when we are using films from these modalities to treat angiographically insignificant areas that may be the source of future ACS events. Local delivery of drugs on current stent platforms or even biodegradable platforms will be a bridge until pharmacological agents alone can be used to stabilize vulnerable plaques. I also see the role of the cath lab expanding into peripheral vascular areas at a very rapid pace. Interventional radiology and interventional cardiology are overlapping more and more, and electrophysiology is certainly another growing area of cardiology.
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