The 10-Minute Interviewwith... Pam Ragland, BS, RCIS

Why did you choose to work in the invasive cardiology field? Congress had closed my former employer (a government hospital) and while working in a transition position, I saw an advertisement that the local tertiary hospital was starting a School of Cardiovascular Technology. I had majored in pre-med Biology, so I inquired about and attended the first class. We trained for all aspects of cardiac technology, both invasive and non-invasive. I first worked in open-heart surgery and several years later, transferred into the cath lab. After a year, I became the cath lab manager, and then a few years later I moved to Maryview Medical Center. Can you describe your role in your cath lab? Primarily, I have managed cath labs, both at a tertiary center and here at Maryview, for the past 15 years, though I was a technician prior to that, and still retain most of my hands-on skills. As a manager, I feel that my primary responsibility is to help ensure the best quality possible for our patients, as well as accomplishing the goal of maintaining a successful enterprise for the facility. What is the biggest challenge you see regarding your role in the cath lab? Staying aware of, evaluating, and incorporating change, both in the technical and financial aspects of our operations. Change is difficult at best (we all have our comfort zones!) and it happens very rapidly at times. Choosing the right direction and obtaining cooperation from all areas involved can be a monumental task. What motivates you to continue working in the cath lab? It’s definitely the constant possibility of challenge as well as the self-satisfaction of helping another person. No two days are ever exactly the same, nor do they ever go according to plan! And you know you’ve arrived, on a personal level, when a physician not only trusts your judgement, but also seeks your advice when there’s a decision to be made. Do you have any memories of especially bizarre cases? There are a few. Among the foremost are: a) The surgeon opening the chest under my hands as I did compressions (papillary muscle rupture); b) A dying patient who remained conscious, alert and talking as long as we did CPR (before LVADs); c) A patient who went totally catatonic as the result of a lidocaine bolus, and remained so for nearly half an hour despite all treatment. Who knew?! Can you share what your fellow colleagues (both physicians and cath professionals) are like? We currently have four physician groups, and I have to say frankly that they are all excellent physicians. I have several that are personal favorites because of personality and/or some of the difficult situations we have worked through together. Individually, they are all good to work with; it’s the group-to-group competition that adds interest to the day! All are highly success- and quality-oriented, and have been very supportive of, and instrumental in, the development and growth of our programs. Our staff consists of a mix of different backgrounds: RN, RCIS, CVT, CNMT, and Paramedics. Of the RCISs, two (including myself) attended an accredited program, one started as a paramedic, and the other is also a RN. The mix works very well, especially as a knowledge resource we hardly ever need to make a call outside the department to accomplish any level of patient care, even if that care involves a non-cardiac diagnosis. We allow cross-training to the various positions according to aptitude and ability, creating a career path for everyone to gain registry status with time, study and experience. The staff have been a primary factor in our growth and a driving force in the quality of our patient outcomes. Are you involved with the SICP or any other cardiovascular societies? I am a current member of SICP and have belonged in the past to others. Are there any websites or texts you would recommend to other labs? Along with cathlabdigest.com and acc.org, tctmd.com, Heart Center Online, Premier Inc (our buying group) and our individual vendor websites (such as Guidant and Medtronic) are all excellent resources. If you could send a message back to yourself at the beginning of your cath lab career, what advice would you give? Open a bakery instead? Actually, there’s little that I would change. One would be reminding myself to take more personal time! As anyone who has participated in call coverage in an interventional setting, or who has been a manager, can tell you, that has always been in short supply since entering this field. Perhaps I would take a few additional college courses that would prove of benefit now. The knowledge and skills I’ve gained, along with the people I’ve met, I wouldn’t change at all. Where do you see yourself professionally when it is time to retire? My job is evolving as we speak moving more into project and data management, and performance improvement for not just the cath lab, but our cardiac service line. We are implementing the move of the noninvasive department, the addition of a third lab, and also an open-heart surgery program, and I will be involved in helping the facility reach its goals in these areas. I don’t know too many 60-year old cath techs, so I suppose that most of us evolve into managers/administrators, vendor representatives, or develop entirely new careers at some point. It is a very demanding field, both mentally and physically. What changes do you think will occur in the field of cardiology in the coming decades? I would expect that drug and gene therapies will become a larger treatment modality; I keep thinking of one of the Star Trek movies where Bones hands the waiting renal transplant patient a pill and she grows a new kidney within hours! We already have the infant stages of angiogenesis and drugs that significantly reduce stent restenosis; they potentially open the door to some very interesting pathways. Heart failure treatment is beginning to expand its treatment modalities and the success of those are promising; we should see more in this field also. We are more knowledgeable about heart disease and reportedly doing more to prevent it; yet heart disease does not seem to be abating, and a growing percentage of our patients are now under the age of 60. I would, based upon current trends, expect more and more of the treatment modalities to take place in the cath lab setting rather than other areas.

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