The 10 Minute Interview with Scott Fylling, RCIS

I have been working in the field of cardiology for the last 18 years. In 1988, I came to Bay Regional Medical Center located in Bay City, Michigan, to help start up their cardiac catheterization lab. I am a father of three children who make me proud every day, and my wife Peggy is a loving and caring person. I have two wonderful grandchildren. Why did you choose to work in the invasive cardiology field? I started out as a paramedic back in the mid-1980's. In addition, I always believed that I did the most good for my cardiac patient. The hospital I was working for had the only cath lab in a 40-mile radius. With all the open positions they had and were unable to fill, they decided to start a CVT program. This program was an idea of the hospital CEO. It seems his first stop in the medical field was to become a RCVT. I applied and was lucky enough to be one of four selected into this program. Cardiology has become my life outside of my immediate family, and I would not want it any other way. Can you describe your role in the CV lab? Currently, I am the manager of the cath lab, non-invasive cardiac testing, and cardiac rehab. I oversee the day-to-day operations of four labs. These labs have the ability to perform diagnostic and therapeutic procedures for both cardiac and peripheral patients. In our EP lab, we have the ability to do A-fib mapping, RF or cryo-ablations, and pacemakers/ICD. Non-invasive testing includes echocardiograms, electrocardiograms, and all types of stress testing and tilt table tests. Cardiac rehab offers phase 1, 2 and 3 for our patients, along with multiple support groups. What is the biggest challenge you see regarding your role in the CV lab? The biggest challenge is getting and keeping three different groups of physicians (cardiology, vascular surgery, and radiology) working together in the area of peripheral interventions. To say we had turf disputes would be an understatement. Moreover, why would anyone believe anything different would occur! If I spent eight extra years training to perfect my chosen medical practice, I surely would not just roll over and die if other physicians wanted to start treating my patients. It started out extremely rocky but has calmed down to a light ripple over the last 8-10 months. This project took us about 18 months to complete. It started with the help of one of our peripheral vendors. We asked them to make us an estimate on potential peripheral caseload based off cardiac volumes. With this in hand, we convened the parties and sold the idea of removing the no-compete clauses they had in their contracts for qualified physicians to perform peripheral angiography. We agreed to have a six-month trial and then reconvene to make our final decision about opening the peripheral arena. I believed final approval would be a forgone conclusion once all parties realized their workload was not decreasing but increasing instead. When all parties decide to work for the betterment of the patient and the facility anything can, and will happen. Accomplishments like this have made us a Solucient Top 100 hospital and we have a 5-star rating from Health Grades. Then, of course, we have the ongoing issues with device cost. Costs are an area that I believe we have done a great job getting our hands around and controlling. What motivates you to continue working in the CV lab? It is the fast pace, ever-changing, and always challenging world of cardiology. It reminds me of the weather in Michigan. It changes daily, sometimes for the better, sometimes for the worse. What motivates me is how we have evolved from taking proximal and distal pressure off the balloon the size of a Swan-Gantz catheter to fixing chronic total occlusions, PFOs, repairing valves, and now the field of peripheral vascular, including carotids. If you get bored in this field, you are not paying attention to what is going on around you. What is the most bizarre case with which you have ever been involved? It was about six years ago in March. We had a patient refuse to have his catheterization because he was feeling a little sick. The physician reluctantly agreed to let the patient wait until the next morning. About three hours later, the patient arrested and was transported back to the lab for an emergent catheterization. The angiogram revealed the patient had only a small left main artery that was still open. Everything else was occluded, with the exception of a small network of spider-like arteries attempting to help the heart survive. The patient had asystole as his underlying rhythm. Therefore, we inserted a temporary pacemaker and an intra-aortic balloon pump to help support him. For the next seven hours, the patient showed no signs of improving. The family, on the other hand, never gave up on their hope and faith that there was still a chance. Every hour, for 5-10 minutes, his wife came into the room, held his hand, and prayed. The cardiologist and I noticed that his heart rate on the monitor increased around 11:00 p.m., to our disbelief. We temporarily paused the pacemaker and his heart was beating on its own at 89 BPM. His blood pressure was almost 100 systolic with the help of the pump. The next day he had open-heart surgery and as of today, he is living a productive life. When work gets stressful and you experience low moments (as we all do), what do you do to help keep your morale high? I think of all the great times I have had with my family because of this jobbeing able to watch my children compete in sports, sing in spring festivals or play in a concert. I think about the places we visited and the places we are planning to visit. I reflect on the successes we have had and visualize where we are planning to be in five years. Life is too short to look at the negative side of things for too long. Are you involved with the SICP or other cardiovascular societies? I joined the SICP in its inaugural year and at that time, was a little disappointed in what I received for the amount of money I spent to be a member. However, I do plan to become a member once again in the very near future. I think the SICP has evolved into a great organization and everyone should seriously think about supporting it. Are there websites or texts that you would recommend to other CV labs? I think cathlab.com is a great site for all types of information. Sites that I use on a regular basis are: www.theheart.org, www.hrsonline.org www.tctmd.com www.acr.org www.blaufuss.org www.ecglibrary.com www.nejm.org These websites cover everything from electrophysiology to peripheral procedures. Do you remember participating in your first invasive procedure? Can you describe what it was like and how you felt? Yes, as if it was yesterday. It was a right/left Sones approach and I think I lost ten pounds during that case. I kept saying to myself, I think I picked the wrong field to work in. I have never felt more inadequate in my life than I did at that time. Everything seemed to be moving in overdrive while I worked in neutral, or maybe even in reverse at times. When asked, How did it go? I remember responding to my trainer, Who knows? I had sweat running into my eyes and my clothing was stuck to my skin. My trainer told me not to worry about it, that if I was not sweating I was not paying attention nor I did care. Thank God we had showers in the male locker room. If you could send a message back to yourself at the beginning of your CV lab career, what advice would you give? Study hard and do not waste your time complaining about the little things in life. That you were correct in saying and reminding staff to always care for every patient as if he or she was your family member. By doing this you will never have any regrets or second thoughts about how you cared for your patients. Where do you hope to be in your career when it is time to retire? I would prefer to go somewhere warm. However, more than likely I will stay some place close to my children. Family is the most important thing a person can have, in my opinion. Therefore, I will try to talk my kids into moving somewhere warm once they graduate from college. Has anyone in particular been helpful to you in your growth as a cardiovascular professional? There have been so many individuals that have helped me grow as a cardiovascular professional over the years that naming one would truly be an injustice to the others. I would like to thank my assistant, Sue Stoffel, and all the staff for helping me to make this department function so efficiently. In fact, our efficiencies have other organizations using us as a ruler for their standards. I would like to give special thanks to my Director, Willa Rousseau, and the rest of administration for having faith in me when they offered me my position. Where do you think the invasive cardiology field is headed in the future? If I could predict this, retirement would come sooner than later. My guess is surgical procedures will continue to decline. I will be working closely with more and more surgeons in the lab to help correct their patients' medical problems. Gene therapy will play an important role for those patients we are unable to help with today's technology. In addition, stents continue to keep getting better and better, and restenosis is starting to become a concern of the past.

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