James G. Beavers, CCP
“What I have learned bears no other fruit than to make me realize how much I still have to learn.” MONTAIGNE (1533-1592) “Of Experience,” Essays, 1588
It is an honor and a privilege to deliver the Thomas G. Wharton Memorial Lecture this year. Thomas Wharton, a non-perfusionist, was drawn to our profession via his interests in technology, engineering, and education. He became the first Executive Director of the American Board of Cardiovascular Perfusion. His passion for excellence in education and vision for creating a strong professional society for perfusionists led to his donating personal monetary funds in 1979 to assist in the creation of the American Academy of Cardiovascular Perfusion. His untimely death that same year prohibited him from seeing the fruition of his dream. Tom was an ardent supporter and friend of the perfusion community. As many who knew him personally have said, “he was one of those who worked behind the scenes, in the trenches, and available day or night for a phone call from any perfusionist with any problem.” One can say with all humility that Thomas G. Wharton made an impact on our profession.
There have been many other individuals, some of them perfusionists, who have also made animpact on our profession. Many of our past presidents, in their own Thomas Wharton Memorial lectures, have illuminated many of these hard-working, passionate people who have contributed to medicine in general, and perfusion in particular. Some of these individuals are: Alexis Carrel, Dr. Jay McLean, Dr. John Gibbon, Dr. Robert E. Gross, Dr. Alfred Blalock, Drs. Kirklin and DeWall, Dr. Denton Cooley, and numerous others. However, the focus of my talk today shall be perfusionists and their impact on our profession and on the many individuals with whom they come into contact.
The topic of my talk, impact, is not a new theme. In fact, many great literary works have this as a recurring theme. Hollywood has also invested millions, in the hope of making millions more, in this theme. As an avid movie-goer I would like to share a few of the movies that have embraced this theme. Of course, the first classic would be Frank Capra’s wonderful holiday movie, It’s A Wonderful Life, in which George Bailey learns what impact the absence of his life would make to the community of Bedford Falls. The next movie, Big Fish, by the slightly skewed mind of Tim Burton, tells the story of Edward Bloom, a traveling salesman and master of the art forms of story-telling, fairy tales, and myths. His son, always a scoffer and unbeliever, ultimately learns at his father’s funeral the impact his father’s life has made on numerous individuals, albeit revealed in slightly different forms than in his father’s fantastic tales. Finally, in Something the Lord Made, by Joseph Sargent we are transported back in time to the true story of the relationship between Dr. Alfred Blalock and his laboratory assistant, Vivien Thomas, as they work tirelessly to create a way to save “blue babies” from the horrible death awaiting them. A new field of medicine is created against the backdrop of prejudice, social inequities and injustices, and the prevailing dogma of medicine at that time: if one attempts to operate on the heart, the patient is doomed to die.
“We are like dwarfs on the shoulders of giants, so that we can see more than [the ancients] and things at a greater distance.” BERNARD OF CHARTES (AD?-1130?)
The following rogue’s gallery of pictures represents some of the individuals who I believe have made an impact on our profession. Let me state clearly that this list is not complete, but reflects only the pictures I could obtain (by begging, borrowing, etc.) in a short time period. I have discovered one of the lamentable problems of our profession, a lack of historical photos of individuals, in professional pose or otherwise engaged, in a single protected archival state easily accessible to those desiring to peruse them. Having said this, I thank Mark Kurusz, Michael Hollingsed, Terry Crane, and others who have provided pictures for our viewing. The following individuals share many of the same character traits found in you and me. They should, for they are of the same fellowship: that of a cardiopulmonary perfusionist. Perhaps they have been placed by fate into the time and circumstance that allowed them to be set apart. Or rather, as I choose to believe, God has allowed them to be part of His eternal plan, the “Big Picture” I cannot see at present. These are the individuals who have passionately and vociferously argued at many educational venues: “to bubble or to membrane” “to pulse or not to pulse, that is the question,” “does arterial filtration matter, and if so, what is the proper pore size,” “alpha-stat vs. pH-stat,” and “blood vs. crystalloid cardioplegia.” As some of these questions were resolved over time and through a preponderance of scientific evidence, new issues arose that were eagerlyinvestigated by curious minds, which ledto further passionate arguments in search of truth: “safety issues in perfusion,” “how much albumin is enough in the prime,” “neurological protective strategies…alpha-stat vs. pH-stat,” “myocardial preservation/ protection… additives, formularies, etc.,” Again, as many of these issues appeared to be within the realm of control by the perfusionist, new problems arose that demanded our collective attention. These same “giants” of our profession eagerly arose to the challenge of understanding, manipulating, and creating the best perfusion practices to be implemented by the main-stream perfusionist when confronted with extracorporeal life support, ventricular assist devices, minimally invasive cardiovascular surgery, and transport of the critically ill patient on various life-support modalities.
Which of the character traits that these individuals exhibit should be reflected within our own countenances? A curious nature imbedded within an intelligent mind, properly trained in the art and science of perfusion; the heartof a lion, willing to face each day’s new trials and uncertainties with compassion, sensitivity, courage, and adaptability; a strong work ethic and a desire to go the extra mile to accomplish the demanding tasks of each day; a voice willing and able to express his/her opinions and challenge others’ ideas in search of truth, and finally, a willingness to sharethe knowledge acquired either through trial and error, success or failure, joy or sorrow, with any medical colleague in order to better enlighten us all. Many of these “giants of perfusion” are sitting with us here in the audience, while some have preceded us into new realms, just over the horizon, in search of truth. Many would say that these individuals were fortunate to have been involved in the practice of perfusion during the Golden Years in which our technology made rapid advances to keep us with the changing face of cardiac surgery. Most of them, if asked, would say it has been a privilege, but a wild, sometimes scary ride on an ever-changing undulating roller-coaster, beset with many twists and turns, demanding a tenacious hold and strength of character to reach this far side of perfusion technology evident today.
“There is no greater satisfaction for a just and well-meaning person than the knowledge that he has devoted his best energies to the service of the good cause.” ALBERT EINSTEIN (1879-1955)
I would like to reiterate that this list was not all inclusive, for I would gladly add many names and faces to the palette of those I feel have made and are making an impact on our profession.This mural of portraits would have to include all the directors and instructors of programs of perfusion education, both past and present, who daily embrace the challenge of educating the new faces of perfusion with very limited resources and exorbitant costs of personal time and effort. My list would be expanded with any perfusion colleague who sacrificed his/her own holiday time with family and friends while allowing a co-worker time away to be with their young children during Christmas; the perfusion colleague who gladly took an extra shift managing an ECMO circuit or ventricular assist device to cover the need of the service; the perfusionist who offered his/her shoulder in support of a tearful family member of a patient undergoing surgery, or showed compassion and sensitivity to the grieving family of a patient being terminated from hopeless life-support. Look around, for many of these “giants of perfusion” may be sitting next to you.
What does it take to make an impact on those around you? Besides the character traits already mentioned and exhibited by those individuals I have highlighted for us today, it takes a “right attitude.” All of us must endeavor to start each new day with the proper attitude and perspective. As we exit our homes and begin the sometimes arduous trek into our workplaces, we need to be aware that we will make an impact on those with whom we come into contact. Will that impact be a positive or negative one? Is your world image for this day being portrayed to all you meet as a “half-empty glass or half-full glass?” Does your external visage reflect the inner peace, calmness, and confidence you feel this new day? Or do your eyes and body language send the message to all that just beneath the surface a roiling mass of perceived slights and injustices threatens to erupt into a fiery explosion of self-righteous indignation, disrupting the professionalism and harmony of the workplace? Daily, each of us has an impact on our sphere of influence and those with whom we come into contact. I hope this message has helped you reflect on your own impact on both our profession and your sphere of influence. May your introspective sojourn bear much fruit, and help you make a good impact on your day-by-day journey of life.
“No productiveness of the highest kind, no remarkable discovery…is in the power of anyone; such things are above earthly control. Man must consider them as an unexpected gift from above, as pure children of God which he must receive and venerate with joyful thanks…In such cases, man may often be considered an instrument in a higher government of the world—a vessel worthy to contain a divine influence.” GOETHE (1749-1832)