“If I Do This, I Cannot Do That”
Diane Clark, MS, CCP
Members of the Academy and honored guests. Some of you found out at this meeting that within the last year I have moved to Gadsden, Alabama. Those of you who know me are a bit surprised because Gadsden, Alabama, is the first town I have lived in that is not really a metropolitan area, but I love it there. Who would not love it in a place where the local radio celebrities are named Rick and Bubba?
When I am driving to work, it is often impossible to get anything but country music on the radio. I do not really like country music, but have come to appreciate the logic and simplicity of some of the lyrics such as, “Whenever I make my mark, someone paints the wall” or “If you are going to act like that, I have better things to do, like wash my car out in the rain.”
In that vein, my talk today is titled “If I do this, I cannot do that.” It will quite obviously focus on choices, both collective and individual, and view some choices through examples and scenarios. The first example shows the wisdom and friendship of the person for whom this lecture is named, Tom Wharton.
Perfusion and Dialysis
I am one of the dinosaurs who knew Tom Wharton personally, and can attest that he appreciated and sometimes guided us through the choices thrust upon us. One of the diamonds in my jewelry box of precious memories is a sweltering day at a dialysis meeting many years ago in Little Rock, Arkansas. When the conference broke off for the afternoon, Charlie Reed, Tom Wharton, and I ventured some miles from Little Rock to the home of Charlie’s dearest and oldest friends, a married couple named Bernie and Al. We spent that afternoon and early evening reading poetry aloud and drinking wine. During the ride back to the hotel, Tom explained to us how the new federal regulations providing Medicare funding for dialysis would cause the interests of Perfusion and Dialysis to diverge.
At the time, the American Society of ExtraCorporeal Technology consisted of perfusionists and dialysis technicians, and Charlie was attempting to develop the schooling at the Texas Heart Institute so that one’s career path could include both Perfusion and Dialysis, but he was running into roadblocks. He and I attended the Dialysis Meeting in Little Rock to gain an understanding of those impediments so that they could be overcome.
After Charlie’s conversation with Tom, Charlie dropped the idea of including dialysis instruction in the curriculum of Texas Heart Institute’s School. Tom Wharton’s predictions proved correct. Dialysis technicians collectively but amicably decided to leave AmSECT, and the professional development of each field has progressed independently of the other. Tom and Charlie did not cause this to happen; the marketplace did that. However, both Tom and Charlie made choices to align with Perfusion rather than Dialysis. Each of them realized, “If I do this, I cannot do that.”
I was a neophyte then, and only soaked up the events and conversations of the day. However, memories of that time help to crystallize several lessons in my mind. The first lesson was that Tom Wharton was a person to whom Charlie Reed listened, and that made him special. The second lesson was that it is easier to make correct and tough choices when we are surrounded by love, compassion, and wisdom than it is to make such choices amidst acrimony and deceit. The third lesson was that sometimes we must choose one path or the other because we cannot possibly travel both paths at once. The fourth and final lesson was that sometimes the most valuable knowledge we carry away from a scientific conference is as much a result of the keen minds brought together there as it is a result of the scientific presentations.
Formation of The Academy
Next, I want to review my personal recollection of what led to the formation of The American Academy of Cardiovascular Perfusion. Some of us reprobates who eventually became Charter Members of The Academy had for some time discussed several observations we had in common about some of the perfusion conferences we had attended. I hasten to add that these observations may no longer hold true, but are stated here in the hope that we will not have to relearn the lessons of the past. One bothersome factor was that committee or board meetings sometimes conflicted with the scientific sessions. Not only did this diminish the attendance at the scientific sessions; it also reduced the input and learning opportunities of those who chose, in the spirit of fraternal dedication, to serve on committees or boards.
Another observation, as alluded to earlier, was that some of the most valuable knowledge was shared in the context of informal discussions that took place during professional conferences. The good part about that was that true learning and exchange of ideas took place. The bad part was that the beneficiaries of such discussion were few in number, and there was no permanent record of such discussion.
As a result of these and other observations, those who established The American Academy of Cardiovascular Perfusion were determined that education would come first at its conferences, and that no other meetings or convention activities would ever be allowed to interfere with the scientific sessions. In addition, ample discussion would be designed into The Academy’s scientific sessions, and that discussion would be recorded and published.
To sum it up, the original members of The Academy decided, “If we do this, we cannot do that.” To keep education as the central emphasis of The Academy, we should probably refrain from other activities which may divert our attention or dilute our resources. Through the intervening years, we have made changes. We now publish a Newsletter, are affiliated with the premier international journal Perfusion, and will probably soon be a sponsoring member of the Accreditation Committee for Perfusion Education. Our original Charter Members are overwhelmingly outnumbered by those who have joined The Academy, but so far as I am able to ascertain, our vision and mission have not changed.
The American Academy of Cardiovascular Perfusion may continue to change, but I hope we will continue to make the correct choices. In my opinion, as we take on more, we should maintain the original focus on education and the furtherance of knowledge pertaining to perfusion. And if the road we are currently traveling should fork, we should recognize that we must choose one path or another; that it is impossible for us to travel both at once and that in attempting to do so, we will become ineffective.
I would like now to spend some time describing how perfusionists are daily presented with
“If I do this, I cannot do that” choices.
- For example,
- If I give retrograde cardioplegia effectively, I cannot keep blood from oozing at the anastomosis site.
- If I maintain cooling and warming temperature gradient limits, I cannot cool or warm with great rapidity.
- If I decrease the flow drastically as the aorta is being clamped and unclamped, I may not provide optimal cerebral perfusion.
Practice should make perfect, and so we should become expert in recognizing when a choice is appropriate, and what the correct choice should be. I have been practicing for over twenty years and still make mistakes, but have learned to recognize and sometimes even laugh at them. There are, I believe, some signs of failing to make appropriate “If I do this, I cannot do that” choices.
First, if we are reluctant to give full or accurate disclosure (to tell the whole truth and nothing but the truth), generally we have failed to make a correct “If I do this, I cannot do that” choice. A simple example of this type of failure is when a surgeon I work with asks what the core temperature is and I am tempted to ask, “What do you want it to be?” rather than answering him truthfully.
A second sign of failing to make appropriate “If I do this, I cannot do that” choices is the inability to keep our promises or commitments, except in the event of unforeseen and unforeseeable circumstances. Our word is like our signature on a credit card voucher. We should only make commitments we know we can keep, just as we should only buy on credit what we know we can pay for. When we find we cannot keep all the commitments we make, it is time to prioritize and make some tough “If I do this, I cannot do that” choices.
In conclusion, we are often faced with choices that can be described by the phrase “If I do this, I cannot do that.” We need to recognize these as choices rather than a decree to just do more or to try to satisfy everyone’s requirements. To shrink from such choices will generally mean that we are automatically making the wrong choice. Two signs that we have failed to correctly make a choice are:
- when we are tempted not to tell the complete truth about the matter, and
- when we are unable to keep our word, or our commitments.
Finally, difficult choices are better made in an environment of compassion, support, and wisdom than amidst adversity, deceit, and ignorance. I hope that each and every one of us will strive to create and work in an environment in which good and wise choices can be made.