The Ten-Minute Interview with: Zokra Musovic, BS, RCIS, FSICP

My life has been greatly influenced, both personally and professionally, by combined experiences from two completely different worlds: one in my native country, Montenegro, the former Yugoslavia, and the other here in the United States. I always had the dream of coming to this country, but I have also always loved my country deeply and nostalgically. Now both of these worlds are a great part of me. The knowledge and experience gained from each fulfills and enhances my life and my profession. This knowledge and experience encompasses many fields, from basic sciences and medicine to journalism and social work. I graduated in my home country with a Bachelors of Science in biology. Before I came to the United States, I was a special correspondent for an ecological journal while working in the Ministry of Internal Affairs, the Commission for Refugees. Upon arrival to the United States, I was a volunteer at the University of Chicago in the Psychiatric Institute where I was engaged in experiments involving the behavioral testing of pharmacologically treated rats. Then I was employed at Sherman Hospital in the cath lab and in the meantime, I completed echocardiography studies at Medical Careers Institute in Chicago. Thus, my career life and personal life have been very diverse, a fact I find very fulfilling. Why did you choose to work in the invasive cardiology field? The evolution of this field has been fascinating to me. I have always wanted to pursue a job that will require cognitive thinking skills and have a challenging work environment. Just knowing that we can change a person's life in a matter of minutes makes me proud. I slept and dreamt that life was joy. I awoke and saw that life was service. I acted and behold, service was joy. Rabindranath Tagore Can you describe your role in the cardiovascular (CV) lab? As a result of my RCIS credentials, received in September 2003, I have greatly increased my role in the lab. I precept new members in their training of cath lab techniques. I am involved with the institution of new policies and procedures, and I am able to access the femoral artery and place the sheath pre-procedure as a welcome service for our physicians. Also, I am approved to place closure devices post-procedure. We are a high-level lab. Therefore, I became proficient in monitoring the hemodynamics as well as assisting with the following: high-risk angioplasty and stenting, Rotoblator (Boston Scientific Corp., Maple Grove, MN), pacemaker insertion, intra-aortic balloon pump (IABP) insertion, distal embolic protection devices and all peripheral interventions, including carotid artery stenting. Likewise, assisting in surgery with endovascular repair of aortic aneurysms has been a great experience. My greatest and most rewarding accomplishment to date has been as lead assistant to a TandemHeart percutaneous ventricular assist device insertion (CardiacAssist, Pittsburgh, PA). Acting as first responder to a CODE CARDIAC is another position which requires me to assess and interview the patient in the emergency room (ER) prior to transport to the cath lab. The variety and intensity of this field and its social nature give me great satisfaction. What is the biggest challenge you see regarding your role in the CV lab? Cross-training. The law in our state limits us from being truly cross-trained in our lab. Due to the restrictions set by Nuclear Regulatory Commission (NRC), you must be a licenced radiologic technologist to set techniques and activate the fluoro pedal. However, keeping everyone on our staff continually learning and cross-trained as much as possible keeps us challenged and engaged in our positions. What motivates you to continue working in the CV lab? I get satisfaction and gratification from the acute nature of the job. We see immediate results in the patient's health, which not only saves and prolongs their life but also improves the quality of their life. Sherman cath lab is a world without borders to me. I feel privileged to have worked with not only American-born people, but also people from many other countries, including China, Korea, Syria, Iran, India, Pakistan, Greece, Croatia, Serbia, Russia, Poland, Romania, Sweden, Philippines, New Zealand, Japan and Puerto Rico. Pleasure in the job puts perfection in the work. Aristotle What is the most bizarre case you have ever been involved in? Our lab does a large amount of high-risk patients and procedures but the most recent and unusual case I can recall would be the placing of a TandemHeart percutaneous ventricular assist device. The patient had presented to the ER four days prior with a dissecting aorta from the aortic valve to the iliacs and had a ventricular assist device (VAD) placed in the OR due to a right ventricular (RV) infarct from a dissection. The patient was weaned off the VAD, but was unable to maintain perfusion. The cath lab call team was called in by the CV surgeon to assist with the TandemHeart device. Having been briefly in-serviced approximately one month prior, we had been unaware of the possibility of being called in the middle of the night to utilize our knowledge of this device for an emergent situation. After arriving, it was found that no other departments had been called, such as anesthesia, the OR team and the cardiologist. The patient was brought to the cath lab. The chest was still open from the previous surgery. The routine for implantation of this device is to access both femoral veins for right heart bypass. In this case, the individual was too tall to place the catheter into the pulmonary artery from the groin, so the internal jugular vein was accessed with some difficulty, due in part to the edema. Due to the large size of the catheters (21Fr), there was a large volume of blood expelled after the dilator and wire were removed. After the catheters were placed in the right atrium and pulmonary artery, the two catheters were then connected to the centrifugal pump to complete the right heart bypass. The procedure itself only took about 45 minutes once the entire team was assembled. The patient was transferred back to the CCU with no further incidents and the patient is now awaiting heart transplant. When work gets stressful and you experience low moments (as we all do), what do you do to help keep your morale high? I keep my morale high by focusing on the pride I have in my job. We as a team give quality and efficient care to all of our patients. Seeing the patients leave the hospital with their families is a morale booster in itself. Are you involved with the SICP or other cardiovascular societies? Actually, the Sherman Hospital cath lab started the Illinois Chapter of SICP just over a year ago and I am the current treasurer. The support from our physicians and vendors has been outstanding. Our last meeting was most successful, with the addition of forty new members and more than 100 in attendance. I am also a member of the American Heart Association, Council on Arteriosclerosis, Thrombosis and Vascular Biology and Society for Vascular Medicine and Biology. Are there websites or texts that you would recommend to other CV labs? I highly recommend: www.tctmd.com www.cardiovillage.com www.theheart.org www.cathlab.com www.sicp.com Dr. Morton J. Kern's book, The Cardiac Catheterization Handbook, Gloria Oblouk Darovic and Cory M. Franklin book, Handbook of Hemodynamic Monitoring, Arnold M. Katz, Physiology of the Heart, and Wes Todd's study guide for the RCIS exam (www.westodd.com). Do you remember participating in your first invasive procedure? It was a day with a constant adrenalin rush. I felt apprehension, yet eagerness. I was scared and excited. If you could send a message back to yourself at the beginning of your CV lab career, what advice would you give? Never discourage anyone... who continually makes progress, no matter how slow. Aristotle There is no road too long to the man who advances deliberately and without undue haste; there are no honors too distant to the man who prepares himself for them with patience. Jean de la Bruyere Our virtues and our failings are inseparable, like force and matter. When they separate, man is no more. Nikola Tesla Where do you hope to be in your career when it is time to retire? I hope that I will never fully retire so I can share my knowledge and experience with those who are interested in this field. Education is the best provision for the journey to old age. Aristotle Has anyone in particular been helpful to you in your growth as a cardiovascular professional? I have been very fortunate to be working in invasive cardiology at Sherman Hospital, which has a strong tradition of being the Heart Specialist of the northwest suburbs of Chicago. Both physicians and staff have been instrumental in my progress and professionalism. They have been friends and confidants that have brought me to where I am today. Our team is very patient-oriented and we constantly share ideas, tips and knowledge for better patient care. Where do you think the invasive cardiology field is headed in the future? The invasive cardiology field has been dynamic for years now and I don't see it slowing down any time soon. New devices are always interesting to me. I look forward to the second generation of drug-eluting stents with new drugs, polymers and stent platforms. Bioabsorbable stents look like promising technologies. Finally, site-specific drugs and gene therapies are more distant, but on the horizon. Regarding imaging, 64-slice CT will be the standard. In regards to procedures, I have noticed more interest in chronic total occlusions, as well as left main stenting, saphenous vein grafts, bifurcated lesions, patent foramen ovale (PFO), atrial septal defect (ASD) and ventricular septal defect (VSD) closures, percutaneous aortic and mitral valve therapies, as well as hybrid procedures where both surgeon and cardiologist perform the procedure. Zorka Musovic can be contacted at Zorka.Musovic (at) ShermanHospital. org

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