The 10-Minute Interview with...Bruce Allen, RCIS

Why did you choose to work in the invasive cardiology field? I grew up thinking that it would be good to be involved in the healthcare field. I worked my way through two years of college in the dietary department of a busy hospital and then decided to continue my medical career as a Corpsman and OR Tech in the Navy. After my tour in the Navy, I completed my Bachelor’s Degree in Biological Sciences. The medical field was still appealing to me but I didn’t want to spend the rest of my working days as a tech in the OR. The OR was always interesting, but I was looking for a vocation that was more technically challenging and would give me a greater sense of ownership in procedures and outcomes. I went to Spokane Community College (SCC) and completed the Cardiopulmonary course with emphasis on vascular technology. The training at SCC was a big help in giving me the understanding of what I would be doing in the CV field before being thrown into a cath lab. It also gave me the basis for passing the RCIS credential. I would recommend that any training program teach the theory before having students do the hands on. Can you describe your role in the CV lab? I have taken on several roles during my 27 years at SHMC, but the most enjoyable is still working alongside the other staff members doing procedures in the labs. As a senior technologist, my other responsibilities have included the development of a standard of excellence in the cross-training program, interviewing prospective staff (to evaluate personal and technical skills) and oversight of inventory. I also enjoy evaluating new equipment, products, and procedures. Many years of experience in the field have given me a keen sense of what is going to work or not. What is the biggest challenge you see regarding your role in the CV lab? The biggest challenge in my role has been keeping up with CHANGE. It can be both a help and a nuisance. Sometimes I sense the patient gets left out of the picture. Maintaining quality of care is something that we are constantly mindful of as our energies are siphoned off by paperwork and learning to use new tools. Furthermore, staff in a cardiac/angio/EP service do over three times as many types of procedures as staff in a cardiac-only lab. This puts a lot of stress on our training and inservice program. The other major challenge is the increasing cost burden that new technologies bring, the complexity of understanding how to properly code them and the difficulty in getting reimbursement for their use. The patients coming to the lab for an intervention expect and deserve experienced and technically sound staff working on them. In the future, we will need to improve hospital-based training programs, because students will begin their practical experience doing interventions without the opportunity to hone their skills on diagnostic procedures first. What motivates you to continue working in the CV lab? There are great, dedicated people with whom I work. And, too, it has been a very rewarding experience to work in this rapidly evolving field of medicine. I have witnessed the transition from strictly diagnostic studies to ever-increasing capabilities to affect a positive change in the patient’s quality of life through advanced therapeutic procedures. I am looking forward to new procedures coming along which will require an expanded knowledge base and experience, even from where we are now. What is the most bizarre case you have ever been involved with? I have seen most cardiac anomalies and a lot of peripheral ones too. I remember a totaled LMCA and the EF was normal. Everything was being perfused via collaterals off the RCA. I will never forget the time we did a left carotid angio and the contrast pulsed with the heartbeat but wouldn’t go up into the cerebral circulation (gunshot to the head with high intracranial pressure). The diagnostic procedures that we did 27 years ago would seem bizarre today. The most reliable way to obtain a cerebral angio back then was to put a 14ga steel needle in the right brachial artery and inject 40cc/sec to get retrograde filling of the right vertebral and carotid arteries. To see the left cerebral circulation, we would stick the left common carotid (and hope there wasn’t much plaque in the way). When work gets stressful and you experience low moments (as we all do), what do you do to help keep your morale high? There are books, seminars and support groups to help people get through hard times. I have found the true source of strength in knowing Jesus Christ as Savior and Lord. He gives the inner peace and joy that helps me look beyond the rough spots in life. I don’t wait for times of stress to communicate with God through prayer. Meditating on God’s Word (the Bible) every day is good mental and spiritual preparation to meet the challenges of each day. Are you involved with SICP or other cardiovascular societies? I am not presently a member of SICP, but I plan to become involved with a local chapter being developed to promote and facilitate continuing education among the cath labs in my regional area. Are there websites or texts that you would recommend to other CV labs? Grossman’s Cardiac Catheterization and Angiography and Morton Kern’s The Cardiac Catheterization Handbook are both good texts. Websites include www.cathlab.com and www.theheart.org. Do you remember participating in your first invasive procedure? Yes, I can still remember my first invasive procedure, but it wasn’t in the cath lab. I was a young Navy Corpsman observing a thoracentesis and when that long needle was pushed into the chest for the third time, I almost passed out. After that I became an OR tech and the transition to the cath lab was fairly easy. When I started in the cath lab it was quite different than it is now. We took cut films (14 x 14) in between cine runs so that the surgeons had static films to look at. This involved using a rapid film changer while injecting the coronary arteries. Since we could not use fluoro while running the film changer, you couldn’t see the injection until the film was developed. The only way to know that the contrast filled the artery was if the same EKG changes occurred during the cut filming as occurred during the cine runs. The monitoring person had to really be on their toes and the tech injecting the coronaries had to develop a sensitive touch to duplicate injections from cine to cut films. We have come a long way since then. If you could send a message back to yourself at the beginning of your career, what advice would you give? If you are asking what would I say to a rookie, I would recommend several things: learn all you can, strive for perfection, stay focused on the job at hand, don’t think you are better than you are, trust and respect your co-workers and most importantly don’t ever forget that there is a real person in the room you are working on called ‘the patient’! Where do you hope to be in your career when it is time to retire? I can’t see retiring yet. I am enjoying working in this field too much. I still have some goals to complete that have to do with training and a regional chapter of the SICP. Has anyone in particular been helpful to you in your growth as a cardiovascular professional? I have tried to improve my skills and knowledge by listening to anyone with a positive suggestion. I have even learned some positive things from a supervisor who was not the best leader, but had some good suggestions. Two people who have been very good role models are Dan Scharbach (Providence St. Vincent Medical Center, Portland, OR) and Todd Chitwood (Oregon Cardiology Diagnostic Center, Eugene, OR). They are sharp technically, sound leaders, and dedicated to advancing the cardiovascular profession. Where do you think the invasive cardiology field is headed in the future? It’s hard to imagine what the field of invasive cardiology will look like in 10 or 20 years. Twenty-seven years ago we were using cine, rapid film changers, catheters formed with steam, and had never even heard of stents. We used monitoring equipment that took five minutes just to balance. If the beginning of my career was night, then the present is dawn. The new day may not be invasive at all. I do believe that invasive cardiology will quickly move to strictly therapeutic procedures. Stenting may become rare, as local delivery of medication and gene therapy are perfected. There will probably be a melding of micro/robotic and intra vascular modalities. Things I never dreamed of when I started in the cath lab. Bruce Allen can be contacted at BrAllen@peacehealth.org

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