1993 Thomas G. Wharton Memorial Lecture

“On A Personal Note…..”

James MacDonald, CCP,CPC
London, Ontario, Canada

Fellow members of the American Academy, Mr.Mead, fellow perfusionists, ladies and gentleman – As the incumbent President of The American Academy Of Cardiovascular Perfusion, it is indeed my pleasure to deliver to you today, the Thomas G. Wharton Memorial Lecture. To present this lecture is a privileged responsibility given each year to the Academy President and one which to date, has been honorably exercised by our previous presidents. This is a special time set aside each year by the Academy to honour the memory of an individual whose individual commitment made a difference. Please bear with me this morning as I deliver this address to you, the Academy membership.

Who Was Thomas Groth Wharton?

Thomas Groth Wharton was a dedicated individual who helped perfusionists to envision their rightful role as an allied health care professional. His name was synonymous with dedication and professional commitment. He dedicated his efforts towards the common good of others so they would realize their full potential. He was a genuine friend to perfusionists and played a key role in the formation of the Academy. Tom Wharton was only too happy to give others the credit for his considerable labors. He was an individual who was eager to remove himself from the spotlight and place it on someone else. Tom was instrumental in the early recognition of the need for a professional organization such as the Academy. His untimely death in 1980 removed from our midst a dedicated and committed person. The Academy that Tom Wharton helped to initiate, he left for you and me to carry on. Someone once wrote that Tom Wharton had one inability. He could not say “no”. Today might be as good a time as ever to review and reflect on our personal commitment to our professional organization. My presentation today will address my views on professionalism. Thus the title, “On A Personal Note”. It is often times difficult to put into the written word one’s personal feelings and impressions regarding their selected profession. There is something about giving a memorial lecture that causes one to review their own professional life and reflect on one’s personal involvement. Although I will not attempt to chronicle my professional life, I will attempt to provide you with my personal prospective of characteristics that I feel have been of assistance to me.

Standing before you today is, for me, a humbling experience. In 1980 I attended my first Academy meeting. In 1981, the year after Tom Wharton’s untimely death, I presented my first paper before the Academy membership. In 1983, the Active and Senior membership of The American Academy of Cardiovascular Perfusion (AACP) saw it fit to vote me in as an Active member. I could not have envisioned that my continued involvement as an Academy member would result in my standing before you today as the President of this dedicated professional body. I have been deeply honoured and, at the same time, humbled by your recognition of me. Permit me to explain how I first became involved in the Academy.

My Introduction Into The Academy

Many of you present here today perhaps are not aware that I am not an American citizen. As a Canadian, I was indeed fortunate to be involved in and directly associated with the initial formation of the Canadian Council of Cardiovascular Perfusion. In the late 1970’s I had decided to work toward the establishment of a national society. Several years had gone by and the time had come to intrust others to carry on what I and others had started. These others of whom I speak were my younger professional colleagues. I must admit to you today that I was concerned about the commitment of these younger perfusionists. Would they build from the foundation that I and others had started? Could they carry on the commitment that I knew to be so necessary? As was true in the growth of all perfusion organizations, the younger perfusionists were eager to seek a more structured professional identity within the Canadian medical community. These eager individuals would go on to exhibit a positive influence on the continued professional growth of this Canadian organization. They give it the dedication and attention to detail that I knew to be so necessary for successful continuation. Time now allowed me to seek another journey into my professional life. The American Academy of Cardiovascular Perfusion accepted me and gave me the opportunity to pursue with them their professional aims and objectives. My colleagues in Canada had also committed themselves and from that commitment grew a strong, well organized national organization now called The Canadian Society of Clinical Perfusion.

On a personal note, please allow me to give you an example of what I mean by professional commitment. Reflecting back to these earlier days, I remember being asked by my friend and co-worker, Andrew Cleland, if he might be able to participate in the Canadian perfusion community. I remember asking Andrew why he would want to get directly involved in the perfusion community. His answer was that he wanted to become involved professionaly with other perfusionists. He wanted to seek an identity with his peers. He wanted to belong to the perfusion profession in a more dedicated way. From that day his commitment to the growth of his profession grew. The Canadian perfusionists recognized his commitment. Several years have passed since that conversation. In support of me as the President of the American Academy, I am very pleased to have present here today my valued friend and daily co-worker, Mr.Andrew Cleland, the President of The Canadian Society of Clinical Perfusion. Our common commitment to professional growth was shared.

The time does come when one should seek out organizational commitment. The Academy allowed me the opportunity to belong to an organization of individuals that not only talked about professionalism but demonstrated it each year by continued appropriate professional actions. The Academy continues to serve as a catalyst for my continued professional growth. On a personal note, I feel that I have gained professionally by my direct organizational involvement with my peers.

Peer Involvement And Its Responsibilities

I want to address the concept of peer involvement and its responsibilities. Is organizational commitment and involvement with your professional peers a necessary prerequisite for continued professional growth? For example, involvement in The Academy will provide you with expansion of your knowledge base as well as an avenue for the exchange of technological knowledge. The purpose of The Academy is to encourage and stimulate investigation and study which serves to increase the knowledge of cardiovascular perfusion, and to correlate and disseminate that knowledge. The Academy will provide you the avenue whereby you can focus on common concerns, share your professional commitment as well as identify with your peers. Identity with your peers is important because it will allow direct interaction and comparisons of perfusion methodologies. This will enable you, for example, to focus on acceptable standards of patient care. In belonging to a peer group, we become a reflection of one another and therefore preserve and enhance the professional image of each other. Organizational involvement requires commitment. Such commitment will promote self confidence and provide the impetus that is necessary for continuing one’s professional career. Peer recognition should not be taken for granted. Peer recognition should never lead to a feeling of superiority. Peer involvement should not contrast one against the other and lead one to a feeling of superiority. A feeling of superiority is a self imposed identity problem. It can lead to self delusion. Such self delusion can be harmful to the individual as well as misrepresenting the true ideals of the national society that you belong to. A feeling of self importance can ultimately deform your commitment to your calling and dilute your acceptance as a valued colleague. Conscientious professionals do not exhibit such traits. Peer involvement should, therefore, promote an organized approach to quality in health care delivery and allow you and me the opportunity to grow together. It takes commitment to obtain personal and professional growth.

As clinical perfusionists, you and I, through study and clinical experience implement the technological knowledge and

experience that we each have gained by the implementation of extracorporeal circulation and related supportive interventions. Such clinical experience must and should be shared within the environment of one’s profession. In the daily performance of our duties as perfusionists, we must interface with other health care professionals such as surgeons, nurses and anaesthesiologists. On a personal note, when I am in my operating room I feel a sense of security in knowing that I can rely on my peers in The Academy for support and guidance. I would not and have not hesitated to tap that organizational support. This feeling of belonging to the Academy is for me, a comforting feeling. I am confident in my validity and that of my profession. You and I collectively must have an organized approach to health care decision-making. We take our rightful place as qualified and essential members of the health care team. Like other professionals we have completed some degree of formal training, passed qualifying examinations, and then are set free to carry on the perfusion related responsibilities that make our professional commitment so necessary. We are called Certified Clinical Perfusionists. For recent graduates and those you have been recently certified, your professional journey has only begun. As a recent graduate, you do not as yet have the clinical acumen of others who have been in the profession for longer periods of time. Ask yourself why you are present here today. I am sure that your answer is that your continued professional development requires an occupational and professional commitment to educational formats and meetings such as that provided to you today by The Academy. Do not doubt the continued commitment of the American Academy in helping you to engage and stimulate your professional growth. The word Academy is synonymous with education. We do not just talk about it, we demonstrate it yearly through our scientific seminars, fireside chats and presentation of scholarships to graduating students. Your presence here today denotes your interest and your approval of what we as Academy members are about. For those present who are not associate members, the Academy not only welcomes you, we also take note of your presence here today. As President of the Academy, please accept this direct invitation to become involved in our professional organization. Your personal contribution will enhance your professional knowledge and that of your peers. Please seek out any member of the Academy. Ask direct questions of our membership. If you are serious about your commitment to membership in The Academy and should wish to become directly involved in strong organizational commitment, perhaps the American Academy of Cardiovascular Perfusion will provide the spark that will ignite the flame of your professional growth and development. Look around you today. Take note of the names of those who are presenting. Decide to add your name to this list. Get involved. Make the decision to share your individual professionalism. Those of us who have been involved in our profession for an extended period of time know well this word commitment. To become a member of The Academy does require ongoing professional commitment. It requires those who choose to serve, to do so generously and freely. Talking about it is one thing, doing it is quite another.

Commitment To The Patient – A Shared Responsibility

On a personal note, please allow me to express my views on another extension of our professional identity, our commitment to our patients. I am not talking about unstructured commitment that could lead a perfusionist to burnout. As individuals, each of us must learn to cope with high degrees of stress in our daily clinical lives. We should and must support each other in the recognition that this is a real possibility. On a personal note, have you ever wondered what your colleagues would think if they could watch you perform your daily clinical duties in the operating room. I am sure that each of us present here today would feel that our perfusion practices are beyond reproach and certainly follow acceptable standards of practice such as those adopted by the Academy in September of 1987. In North America alone, each year Perfusionists assemble the heart lung machines, CO2 flush and prime the extracorporeal circuit, initiate, maintain and discontinue cardiopulmonary bypass over 350 thousand times. During this Academy meeting, we will share in our methodologies that hopefully will result in an organized and acceptable standardized approach to our specialized involvement in direct patient care. Being a perfusionist is much more than establishing the extracorporeal circuit of choice and conducting cardiopulmonary bypass. We must remind ourselves that the recipient of our specialized care, the patient, deserves special mention.

Please allow me to expand on this. In a chapter from the book entitled “The Heart of the Healer” by Ernesto Contreras, M.D.; the chapter “Passion, Compassion and Medical Practice”, reminds the reader not to consider the human body purely as a complex machine that can be repaired by advanced technologies. As perfusionists we speak of interfacing the extracorporeal circuit with all its associated pathophysiology. Collectively, as an organized group of professional individuals, we should from time to time speak openly of our commitment to our patient, the recipients of our specialized technology. Indirectly we do just that by our attendance at this meeting. On a personal note, have you ever felt that no one in your operating room, save the other perfusionist, really understands or can appreciate the true responsibility that you as a perfusionist have. I realize that we get support and recognition from the surgeon, for example. After all, if you and I do our job perfectly, the result could be that no one will notice. We know that to be a clinical perfusionist is to belong to a quality control profession. For the well being of our patients, we cannot make a mistake. When mistakes are made, it is just as devastating to the perfusionist as it might be to our patient. If I had one wish for you today, it would be that I could shield you from the reality of a perfusion misshape. If not at first, in time other health care personal in the operating room professionals will eventually understand your unique and important role. That sometimes feeling of isolation soon disappears. If from time to time you should feel that isolation, console yourself in the fact that your patient also needs understanding, compassion and sensitivity. From time to time you and I must explore our personal commitment to our patients. Into your hands and mine, the patient has entrusted their very well being. We must be protective of that trust. We must reflect on our personal and unique commitment to patient care. As perfusionists, we are a selected few in numbers. Did we not become perfusionists so that we could positively affect the lives of others by offering them freedom from pain and relief from suffering. This is not only the domain of nurses and surgeons. I mention this today only to remind ourselves that our inability to seek organizational affiliation will have a negative effect on your health care delivery. We must share in our commitment.

Similar to the physician, we as perfusionists, must also follow two fundamental rules: 1) The Golden Rule: Do to your patient as you would have done to yourself. Is this not a basic precept in training our students? Do we not teach our students to treat the patient as if they were a family member. 2) The Second Commandment: Love your patient as yourself. No code of ethics can demand this of you and me. This moral/ethical decision must be exacted from ourselves in our daily care of the patient.

On a personal note, I entered our profession in the days of the rotating disc oxygenator, whole blood primes, stainless steel connectors, bone wax and hospital-made tubing packs. I tell you this today because I am very proud of my initial thrust into perfusion. Believe me when I tell you that from initial beginning grew my deepest love for and respect of our profession. That I could eventually play a role in operating a heart lung machine was something that I had wondered about as I assisted the cardiac surgeon during those early days in open heart surgery. I was in awe of these people called heart lung technologists. My duties as an operating room technician caused me to gain insight into the importance of this specialized role. These heart lung technologists were a different breed of people. This unique interfacing with the patient required such dedication. We lost many of our patients in those earlier days. It would not be until later that I would realize that other perfusionist had traveled this same road. For the time being, my whole world would exist in that one operating room. When I reflect back to those earlier days I think of the tremendous opportunity presented to the younger perfusionists today in being able to share experiences through peer involvement. Anyway, these heart lung technologist fascinated me. I wanted more involvement in this life and death drama. The chief technologist and the chief cardiac surgeon realized my interest in perfusion. I suppose I drove them crazy with my constant questioning. These professionals demonstrated to me what respect for the patient meant. No patient was ever to be called the valve, the ASD, VSD, etc. To do so was to bring about much indignation. To this day, when the patient first enters my operating room I am still humbled by my personal opportunity to participate in the well being of this person. From that moment on the patient becomes dependent on me as the perfusionist. I become committed to his/her total care. It is a sacred bond. The stranger becomes my patient. Perhaps this is what Dr. Contreras is referring to. We must integrate the technology of perfusion so as to benefit the person called a patient. To me, they are one in the same. I often find it interesting that we would not hesitate to show empathy to a neonate, a baby or pediatric patient. We would agree that all patients, no matter what age, deserve and expect your professional best. As perfusionists we may feel our contact with the patient to be somewhat isolated. If this is true, go over to your patient and make eye contact. If appropriate at that moment, tell him who you are and also tell him that YOU will take excellent care of him. Do not be afraid to demonstrate caring for your patient in the operating room if others are too busy with the day to day routine. Lead the way and perhaps others will follow your example. Demonstrating your professional commitment to your patient will remove the temptation to treat only the disease pathology and not the patient. This is not reserved only for the surgeon, nurse, etc. You and I must share in this responsibility.

The Relationship Between The Mentor/Mentee

For those of us who accept the added responsibility of teaching students in the clinical arena, your commitment continues. You then become the mentor. The developement and exploration of ideas is promoted within this mentoring relationship. It is for me an exciting and humbling experience to share ones years of acquired clinical knowledge with others who have made a conscious decision to join our profession. Teaching the student requires the development of a mentor/mentee relationship. We must at first make the assumption that this individual has at the least a basic understanding of what his/her chossen profession will expect of them. Within each perfusion school, teaching formats are developed and the perfusion instructor must follow established guidelines which dictate an organized and acceptable teaching format. On a personal note, when I first introduce the student perfusionist to the operating room, I often times feel quite humbled by the experience. This operating room is the daily environment where you and I practice the art and science of perfusion technology. University Hospital in London, Ontario is a teaching hospital associated with the University of Western Ontario Medical School. As a Patient Service Department within the hospital, several years ago my department accepted the added responsibility in becoming a clinical training site. Each year it is both my responsibility and pleasure to lecture perfusion students on the History of Cardiac Surgery And Extracorporeal Circulation. The school allows me three hours to complete this lecture. These three hours allow me my initial interface with these individuals who have demonstrated a desire, not a commitment as yet, but a desire to become what it is that you and I are. In the introduction to perfusion, I try to point out that this profession with all its associated technology will expect, if not demand, an intense interaction with the patient and latter, if they are successful, the opportunity to involve themselves in the perfusion community. I discuss the uniqueness of our responsibilities as perfusionists with honesty and professional pride. I then proceed to expand on the responsibilities of the clinical perfusionist and how these responsibilities may differ from other health care professionals. I try not to isolate the student from the reality of our world. I am also careful not to lose this initial opportunity to self importance. I emphasize our unique involvement with the cardiac patient. Throughout the lecture I speak respectively of our success and passionately of our failures. I explain how we as perfusionists can positively or negatively affect the very well being of the patient. Within the confines of our profession, I share with them that this new professional venture will carry with it considerable and different responsibilities. Meticulous attention to the every technological detail is essential. Injury or death to a patient is a possibility if strict adherence to an established protocol is not maintained. I teach that our responsibilities requires an intensity of focus. I remind the student that a perfusionist must exhibit honesty, compassion, enthusiasm and yes that word commitment does come up. I teach that the operating room is where we put scientific theory into sound clinical practice.

Students must be treated in a professional manner and they can only learn if you as a professional are genuinely connected to their individual needs. Sometimes, you must support them in their deciding whether to continue in this specific profession. Teaching is more than lecturing. It is demonstrating clinically to the student what it is that they have learned in the classroom. You must transform your teaching on perfusion technology into the clinical reality of what it is that we do and at the same time you must focus on the patient as the ultimate recipient of the your individual care. As a mentor you must encourage full development of potential, even when it means extending beyond the mentor’s own abilities. When you cannot find an answer in a text, involvement with your peers can be of great assistance to you in answering that question. The clinical interfacing of the student into our working environment must be exercised as if it were a sacred trust. It is the direct clinical interfacing of that knowledge, combined with your personal desire to impart your clinical expertise, that hopefully will ensure the successful integration of this student into further professional commitment. Like it or not, you must become the role model and the student must decide if your technological skills as a perfusionist should be emulated. To have such influence on the student may result in his/her successful integration into the network of our profession.

A Definition Of A Professional

As perfusionists we must be able to define the criteria that must be fulfilled to insure that we can indeed call ourselves professionals. We all realize that to be called a professional is to be held in high regard in society and is expected of us by other health care practitioners and licensing bodies. In society there is little doubt as to the professional identity of the cardiac surgeon, the nurse or the anaesthetist. To obtain the status of a professional is one thing. To be able to practice it and act it out is quite another. Wilbert E. Moore, in his book entitled ” The professions: roles and rules” defines a professional as having the following criteria: practising a full time occupation which comprises the principle source of his income, a commitment to a calling; that is, the treatment of the occupation and all of its requirements as an enduring set of normative and behavioral expectations, authenticated membership in a formal organization that will protect and enhance its interests, advanced education which allows useful knowledge and skills obtained through specialized training, service orientation so as to perceive the needs of individual or collective clients that are relevant to his competence and to attend to those needs by competent performance, and finally, autonomy that is restrained by responsibility, thus allowing you and me to proceed by our own judgement and authority. What I have just described is the basic criteria that defines the role of the recognized professional. This allows the clinical perfusionists to fit within the context of the health care system as a whole.

Commitment To A Calling

Does commitment to the perfusion profession go beyond the clinical commitment of the hospital? Does it involve the identification with professional peers and the profession collectively? And thirdly, is such a commitment expected for both continued professional growth and clinical competence? Does this individual and collective commitment result in a common bond. The response should be a definite yes. Your individual decision not to commit yourself to your professional colleagues will limit the sphere of your practice and would then reflect in your ability to provide optimal patient care. The individual commitment of each person attending this meeting is necessary in our continuation as a professional body with a common desired response. Commitment cannot be legislated but your colleagues can insist on it. The Academy does insist on participation from all its members over a three year period. In effect, to remain as an Academy member we are asking for and insisting on your professional commitment to our educational organization. It is a necessary prerequisite for continued membership. Membership opens the door and commitment insures that it is kept open.

Professional Conduct

To be a Professional does carry with it added responsibilities. For example, the professional conduct of the clinical perfusionist must be beyond reproach. If, for example, I should undertake to do something which would be considered to be unprofessional, it would reflect not only me but also my peers. To address this problem, The American Academy and other organizations develop a code of ethics and/or standards of practice. We then in effect demand appropriate conduct from each other to insure that our common bond is not compromised thus reducing the risk of impropriety. In the end, one’s conduct is self regulated by the organizational commitment and continued professional service to the patient is maintained. If as a perfusionist, your personal caring of the cardiac surgical patient does not receive a very high priority, you fail in the attempt to provide dedicated professional service and the patient is compromised. Perfusionists who compromise patient care are not tolerated. Belonging to an organization of peers that demonstrate these norms and provides

continuous demonstration of dedicated professionalism is to be a member of The American Academy of Cardiovascular Perfusion. Each of us must measure within ourselves our personal commitment to our profession. As the President of The American Academy of Cardiovascular Perfusion, and on behalf of our membership, I encourage you to become committed to your profession. The Academy is the place for that commitment. Tom Wharton would agree. Hopefully, you do also.


The professions: Roles and Rules, Wilbert E. Moore, Russel Sage Foundation, New York

The Heart of the Healer, Edited by Dawson Church and Dr. Alan Sherr, Published by Aslan Publishing, New York, N Y, 10032 and Mickleton House, Mickleton, Gloucestershire GL55 6RY, England