The 10-Minute Interview with Gerald Lagasse, RCIS

Why did you choose to work in the invasive cardiology field? After I came back from Vietnam in 1969, I was angry at our American society with its attitude and behavior towards myself and other returning veterans. I bought a Harley-Davidson and joined a segment of society that was less judgmental and more accepting. I spent quite a while biking, partying, and living a life of simple expectations (another ride and another party). One morning I woke up and experienced what George Carlin would call a vu-ja-dey moment. I saw myself as a forty-year-old something, still riding and partying, but with long white hair. I suddenly realized that I was wasting my life to get back at a society that didn't seem to care. That day I decided to find a purpose for my life; a reason for living that had meaning. I started to look around for my holy grail. I thought about the fact that my dad had died when I was four while in the hospital and after being misdiagnosed. He was being treated for a heart condition, when actually he had a ruptured appendix he was 32. I also thought of my mom being surgically treated for a slipped disc. Then it was discovered she had breast cancer and was given six months to live she was 44. I then thought about my last six months in the military, where under operation transition, I spent time with Bendix Commercial Service in the San Francisco Bay area. Can you describe your role in the CV lab today? I am a resource person, educator, radiation control officer, and a pretty good scrub assistant. Every day, I work in the lab performing the duties of scrubbing, monitoring, and occasionally circulating. I also teach diagnostic and interventional fellows, staff, and student nurses. I am also a reference book. Dr. Bernhard Meier said it best in his book Invasive Cardiology - A Manual for Cath Lab Personnel: They [cath lab assistants] typically see and participate in all the cases performed at an institution. They assimilate the experience of all physicians practicing in the particular institution collectively, and they add their own continued professional education and brainpower. They are the living reference book and equipment manual for the physician. We have a career ladder at our institution, with the highest level being IV. Through every level, each technologist is evaluated for his or her technical knowledge, skill, and professionalism by all of their peers. Two interventional cardiologists also evaluate the technologist for their knowledge. A committee comprised of three technologists, one nurse, the department director, and a representative from Human Resources does the final evaluation. At our facility we have over 25 staff. Half of these staff are technologists, of which half hold the RCIS credential. There are only two level IV technologists at our lab. I am one of them. What is the biggest challenge you see regarding your role in the CV lab? Hungry staff. I enjoy edge-of-your-seat new procedures. I recall a few years ago when PTMR (Percutaneous Transluminal Myocardial Revascularization) came out. I loved it! I was getting paid to play a pinball game. Now I find myself having to compete with the young staff who also enjoy new toys. What motivates you to continue working in the CV field? Alimony, child support, house and car payments are the first things that come to mind. Actually, I feel lucky. Vietnam and my poor attitude upon returning eventually resulted in my finding a career where I could actually help people. I discovered that I enjoyed doing that. In America today, studies show that 80% of the working class hate their jobs. I still enjoy going to work. What more do I need? What is the most unusual case you have ever experienced? I must admit that it was not my own case; rather, the honor belongs to Kim Anderson, RT(R). It was many years ago defined as before stents. It was the middle of the morning in the middle of the week. The patient, in her mid-thirties, was in process of having a massive MI. What made it bizarre was that she was also having a baby. Saving a woman's life and assisting with the birth of an infant was the happening thing that Wednesday. The mother's life was saved and a healthy baby delivered. Unfortunately the mother's MI left her with an ejection fraction of When work gets stressful and you experience low moments (as we all do), what do you do to keep your morale high? Yes, over the years I've definitely experienced low to very low moments in the cath lab! Over the years, I have picked up some memories that come back during these times to help me realize that life isn't so bad. I have three memories that help remind me of this. First, I once worked as a senior test technician for a computer company. I recall working in a clean room, and on the other side of the window there were hundreds of women working in rows upon rows, looking through microscopes as they assembled computer parts. Hour after hour they spent behind the microscope, occasionally lifting their hands when necessary to be excused to go to the bathroom. There are many miserable jobs out there, and being a cardiovascular technologist is not one of them. Second, during the mid-eighties I remember on a Thursday working all day with Dr. Enrique Leguizamon. I went home around 5:00 p.m. and got called right back in. We had to do a renal angioplasty, but first had to call a surgeon in to do the femoral cut-down. I was scrubbed with Dr. Leguizamon from 6:30 pm that evening until past 8:00 am the following morning. The patient finally went back to the floor and I went home. Dr. Leguizamon, on the other hand, stayed with the patient until almost noon that day. He demonstrated to me dedication, perseverance, and love of the job. And finally, a friend of mine, Jimmy, contracted MS about ten years ago, at which time he was physically trim and muscular. Six years ago, my friend Rod and I took Jimmy, who now required a wheelchair, to the Chicago Blues Festival. Five years ago, Jimmy could only use one arm, had lost most of his vision, and could only mumble words. For the last three years he has been paralyzed from his eyes down, requires a ventilator and intravenous feeding. Jimmy has not moved in three years. I have been told that this man who used to beat me at chess is no longer able to think. Jimmy showed me that life is short and to enjoy every precious moment, because you never know when it is going to stop. Are you involved with the SICP or other cardiovascular societies? For years, I was a member of one particular cardiovascular society. Every year they sent me a bill for membership, and then I would not hear from them until the next due date to renew. I got frustrated with the fact that all their symposiums and meetings were (it seemed) in Texas, California, Florida and other southern regions of the country, and never in the north where I could afford to attend (not all hospitals open their coffers for staff education). At one point when we were setting up a career ladder and I called the them for help, I got a call back six months later. I decided I was wasting my money and stopped my membership. I then tried a membership with another society for one year, but never renewed. I felt the membership dues were too high when I had ongoing house payments, car payments, and grocery bills. I do go to the yearly conference and enjoy it thoroughly. I am happy to pay the additional non-member fee to attend. I just wish annual membership fees were less, or could be on installment to make them palatable. Other than this, I keep my CCI (Cardiovascular Credentialing Inter-national) certification up to date. I am also on the editorial board for Cath Lab Digest and have written several articles for that publication, as well as Pulse. Are there websites or texts that you would recommend to other CV labs? Websites and online newsletters I would recommend include: newsletter@newsone.mdlinx.com, tctmd.com and cathlab.com. These are all great places to learn and receive information. Books I would recommend include: Invasive Cardiology A Manual for Cath Lab Personnel by Sandy Watson; Manual of Interventional Cardiology by Drs. Mark Freed and Cindy Grines; The Cardiac Catheterization Handbook by Morton Kern MD; The Device Guide by Drs. Mark Freed and Robert Safian; Interventional Cardiology by Dr. Eric Topol; Cardiovascular Dynamics by Dr. Robert Rushner; Cardiac Catheterization and Angiography by Dr. William Grossman; The Heart by Netter (a great visual book). Do you remember participating in your first invasive procedure? Can you describe what it was like and how you felt? Most definitely. The year was 1978. Dr Enrique Leguizamon had been making visits to Europe throughout the summer. In the fall, he returned from one of his visits and informed me that new equipment would be arriving shortly, along with a company representative to assist in its setup. I was to look over the equipment and be prepared to use it within the week of its arrival. The company representative had little knowledge (he™d just been hired) and I found I could read the instruction sheet, (not sheets but sheet), as well as he could. With the equipment put together in what I hoped was the correct configuration, we set off on our historical journey. Our first case was a straightforward LAD lesion. Dr. Suarez, the chief of cardiac surgery, was in the back room along with the anesthesiologist. The surgical staff was in the hallway with a cart. The catheters were monstrous 10 French catheters made of no-memory plastic. The balloon catheters were all fixed wire tipped in two configurations. They were curved or straight. Comparing them to today™s balloons would be like the differences between a Lincoln Town car to a VW Beetle. There were three of us scrubbed in: Dr Leguizamon, Tom Spigelmoyer and myself. I don™t remember much of that procedure except that the balloon didn™t behave as easily as promised. The catheters didn™t stay in the coronary as hoped. The case lasted more than two hours and all I kept hoping for was that when Dr. Leguizamon pushed the foot pedal to activate the inflation cylinder, that it would work right. Fortunately, the case was a success, and thus began our adventure into invasive cardiology. If you could send a message back to yourself at the beginning of your cath lab career, what advice would you give? I would say to my earlier self: Gerry, you came into this field to make a difference. You thought that you™d be doing diagnostic procedures only but that you would do them well. You™re wrong and you're about to go on the wildest trip of your life. Enjoy your career and don™t sweat the small stuff (administration, staff politics and egos) because at the end it really doesn™t matter. We all grow old and then eventually realize that the more things change, the more they remain the same. To this day, I still like what I do. I feel lucky. Where do you hope to be in your career when it is time to retire? I'm already in the sunset of my career, so I™ve a pretty good idea what lies ahead. I found a comfortable and satisfying niche for myself working in the cath lab procedure room. The more complicated and difficult a procedure, the better I like it. I was introduced to interventional cardiology in 1978 and fell in love with it. I never had any desire to go into sales. I did the supervision stuff back in the early eighties and got burned out on the stress of meeting schedules, childish physicians, pushy salesmen and frustrating staff. I still remember an incident that happened twelve years ago that kind of put it into perspective. I was performing a percutaneous stick on a patient™s right brachial artery. The patient (a wealthy, retired executive) looked at me and asked me how long I'd been doing this and if I liked my job. I looked at him and said yes, I liked my job, even after sixteen years. He then looked at me right in the eye and said, I worked at Upjohn (now Pfizer) for thirty-seven years. Seven of them were good. Then there was a long pause, a sad sigh and looking directly into my eyes, he said, The rest was awful. A nicer car, house or better financial retirement would be nice, but the executive made me realize something that was more important. It doesn™t matter how much you make, or how important you appear to the rest of the world. It™s our personal sense of self and our own personal sense of satisfaction that are important. So, retire? That implies a lifetime of tedious work and that at retirement I can finally relax. However, after almost thirty years of helping save lives, I still enjoy my job, my life with my kids, my bike and my garden. I'll retire when the sun no longer shines. Has anyone in particular been helpful to you in your growth as a cardiovascular professional? Dr. Enrique Leguizamon, who was trained by Dr. Mason Sones. He was my chief of cardiology for many years. He took our lab from diagnostics-only and built an interventional program beginning in 1978. He also brought nuclear, rehab, echo, and cardiac symposiums to our institution. You had to know cardiology procedures and be sure of everything you did when he was in the lab. If you yelled PVC in a procedure, out of the corner of his mouth would come, That™s nice. Now is that a right or left ventricular PVC? I assisted him in our first interventional procedure, first peripherals (mid-1980™s), first renal intervention (mid-1980™s) and first carotid (1992). Dr. Leguizamon went to a symposium in 1982, spent a month working with administration and then showed up in the lab one day, saying that I was going to begin learning to put in arterial and venous sheaths, and today was the day. To keep myself from appearing like an idiot required constant vigilance and a willingness to learn and remember what I was told. He was a fantastic educator who liked curiosity in staff and would teach staff during a procedure. He was also someone who couldn™t stand people asleep at the wheel. Those people didn't last very long in our lab. Where do you think invasive cardiology is headed in the future? You ask about the future of cardiology? Do you remember the TEC device? How about DCA? ELCA? LBA? They were all devices listed in the Manual of Interventional Cardiology (1992) as the future of cardiology. They aren™t even around today. I™d rather look at something more focal to us the staff working in the cardiac cath lab. Back in the 1970™s, an internist could call himself a cardiologist and poof he was a cardiologist. Dr. Melvin Judkins is a case in point. He was trained as a radiologist. Today there are numerous subspecialties in cardiology, all requiring board certification diagnostic, interventional, nuclear, EP, peripheral, carotid, echo, etc., all of which require board certification. In the 1970™s, a cath lab consisted of a simplistic X-ray system, a monitor for pressure and an EKG, a power injector, and a 02 sat machine. Today you have sophisticated X-ray and monitoring systems, IVUS, pressure wires, flow wires, thrombectomy devices, balloon pumps, rotoblator, stents, balloons¦ the list goes on and on. In the 1970™s, cath labs often filled staff positions with people literally off the street. Today sadly, cath labs are still literally hiring staff off the street. In the 1980™s, our hospital had twenty-one nurses in the education department. Today there are four. Where are new cath lab staff personnel supposed to acquire their professional knowledge? You have physicians continually being asked to meet higher and higher standards in order to satisfy acknowledgement of a professional status. We have equipment more complex than ever imagined in any Jules Verne book, yet there™s less money for staff training. From my experience, I see little effort on the part of most cath lab staff to improve their knowledge and skills in the very area that is their livelihood. They are busy living life kids, sports, gardening, boating, skiing and painting the house take a front seat to their professional careers. Being considered a professional nurse, RT, CVT, etc., is all that is considered necessary. I remember dealing with a new ARRT staff member a number of years ago. He had seventeen years medical background with the last nine in diagnostic. After a near-traumatic procedure I asked him, why didn't he call off the VT? He said, I'm hired to scrub, not to know EKGs. He didn™t last very long after the incident. Isn™t it about time that staff step up to the plate and at the very least acquire a competency level that can be used as an appropriate measure of someone working in a cath lab? How about if we step up to the same plate as the physicians have and require all staff to become RCIS? Let™s face another reality check. We've been bickering with each other for almost thirty years as to what is a professional standard for the cath lab. Nurses are saying, me, me, I'm the most professional. RTs are yelling me, me, I™m the most professional. In the meantime, PAs and NPs are slowly ˜invading™ the labs and performing functions you are already trained for, but aren™t doing because you™re all still fighting and saying me, me, I'm the most professional those other para-professionals aren™t. And the physicians and administration are saying, These [staff] aren™t professionals, let™s get some PAs! Come on, let™s get professional and prove we know what it means to work in the cath lab. Let™s get into the twenty-first century and all become professionals. Let™s all agree to a common standard Registered Cardiovascular Invasive Specialist (RCIS) as the beginning reference point for a true cardiovascular professional.

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