SICP: 10-Minute Interview: Dan Scharbach

Why did you choose to work in the CV field? I grew up in a small farming town in eastern Washington. Our high school advisor (and basketball coach) did not really provide a great deal of future planning for the graduating students. I was also facing a career placement test, which suggested forest management (logger). So my options were, should we say, "open." My sister, who was a RN, mentioned a new program at the local community college. She was on the first open heart team at Sacred Heart Hospital in Spokane, Washington, and had exposure to the cath lab team. She knew of the brand new Cardiopulmonary Technology program, which had been started in order to support a growing procedure base. After a visit to the college, and a discussion with an individual who had just received her degree in the first-ever graduating class, I signed up. After I watched my first cardiac cath in 1971 and the nausea passed, I was hooked. I have enjoyed this field ever since. Can you describe your role in the CV lab? I have regional responsibility for invasive cardiovascular services in the Providence Health System hospitals in the Portland Service Area. Invasive services are currently provided at Providence Portland Medical Center and Providence St. Vincent Medical Center. These services, under the umbrella of the Cardiovascular Lab department, include diagnostic and interventional cardiac, diagnostic and interventional radiology/specials and arrhythmia services. I also have responsibility for perfusion services at Providence St. Vincent Medical Center. I view my primary roles as being a leader, providing vision, and most importantly, supporting the front-line staff. Having worked in front-line patient care for over 20 years, I know direct patient care is what really counts. These departments have some of the most highly skilled people with whom I have ever worked. I respect and appreciate the work the staff does every day and night. Although I no longer do direct patient care, I believe my years in this role allow me to better understand the needs the team has in order to continue performing at a level of excellence. It may be through the purchase of equipment, support for education, or even the smallest of actions to make their work easier and more rewarding. If this happens, quality patient care will follow. Lately, much of my time has been consumed with building projects, capital purchases and new initiatives. Our cardiac services are expanding and we have several building projects at multiple facilities, which consume much of my time. I am also involved in statewide and corporate initiatives. Cost reduction and operational issues are an everyday part of my work. What is the biggest challenge you see regarding your role in the CV lab? My biggest challenge is time. I identified one of my primary roles as providing vision. Very often, I feel this is an area that gets shortchanged due to the many other tasks which need to be completed. These tasks are very important to the continued operation of the CV services, but without vision it is almost impossible to maintain excellence. The flip side of this challenge is to avoid becoming so much of a visionary that you lose contact with what is happening at the patient care level. Everyone hates the flavor of the month initiative that has no real benefit to the patient, customer or staff. The real trick for anyone in a management role is to be able to identify what is important, and the farther away you get from real patient care the harder it is to make the connection. What motivates you to continue working in the CV lab? A combination of comfort, adrenaline and satisfaction. I have been in this arena for almost 35 years. I know what to expect, but at the same time I never know what is going to happen on any given day. I can start my day with a schedule and end it having not done a single thing on that schedule because other issues took priority. Then there is the adrenaline. Anyone who has worked in a cardiovascular lab knows the adrenaline rush you experience when a complex case rolls into the department. Finally and most importantly, the one thing that has been most satisfying to me has been the ability to interact and help patients. Whether you are a direct patient caregiver, housekeeper, materials specialist, administrative assistant or in any of a hundred other job roles, they all make a difference. Being part of this team keeps me coming back. What is the most bizarre case you have ever been involved with? Many years ago our team got called in during the middle of the night for an acute coronary procedure. The patient was a middle-aged female and very interactive during our procedure. Upon injecting the RCA, we discovered a tight mid lesion. Immediately the patient coded, and after a long resuscitative effort, the patient expired. Not more than two minutes after this occurred, we were notified of a second acute case in the ED. We swiftly readied the cath lab for the next patient and received the patient within 20 minutes of being notified. This patient resembled the first acute patient, a middle-aged female and again quite interactive. Incredibly, upon injecting the RCA, we discovered a tight mid lesion almost identical to the first patient. To our horror, this patient also immediately coded and again, after a long resuscitative effort, expired. Of course, many other factors contributed to these events, but these back-to-back losses were two of the most bizarre cases I have witnessed. They also represented one of the most difficult times of my professional career. When work gets stressful and you experience low moments, what do you do to help keep your moral high? I try to keep the 5-year rule in mind. A person I respect shared this rule with me many years ago. When something seems to be important, I ask myself if it will be important five years from now. Direct patient care issues being the exception, most of the time the answer is no! This is most often true for those turf issues we all look forward to. I also love to utilize humor in the workplace. Sometimes sick, and I am often told, not so funny, but I find humor to be a stress reliever and an oasis in the middle of a bad day. But the most important moral booster for me is my wife and kids. I start looking forward to our next special event, the weekend™s soccer and basketball games, or just watching television together. Are you involved with the SICP or other cardiovascular societies? I am a member of the SICP. I am past Chair of the Novation Cardiovascular Council and participate in several other advisory boards/leadership councils. I am also Director of the Northwest Cardiovascular Management Association (no one else would volunteer). This group of cardiac managers from six northwest states meets for a yearly three-day meeting. It is a wonderful meeting with a great deal of information and friendly networking. Are there any websites or texts that you would recommend to other CV labs?  CD Training Module: Procedural Skills for the Cardiac Cath Team (Mosby-Year Book Inc.)  Books: The Heart by Netter  Websites: cathlab.com and tctmd.com Do you remember participating in your first invasive procedure? Unfortunately, I do. I was working with a very difficult cardiologist. In the middle of the case, the Paley manifold failed. For those of you who have not visited the Smithsonian Museum of Science, the Paley manifold was a steel 3-gang manifold, which looked more like it came off of a 1964 Chevy than an actual medical device. I had the opportunity to assemble these many times in my training and was able to put the new manifold together in seconds. It scared the death out of me and helped me at the same time. If you could send a message back to yourself at the beginning of your CV lab career, what advice would you give? I would tell myself to worry less and not work quite so much. I see some people today working many extra call shifts and additional overtime. I did this for many years and I really can™t say that it benefited me to any great extent. I missed some very important times with family and friends, and this is time you just can™t get back. In some ways, I am still trying to learn this. Where do you hope to be in your career when it is time to retire? I don™t think too much about where I want to be in my career at any given time. I view it more as a question of am I happy in what I am doing and am I continually being challenged in my work. If these two areas are covered, the rest will follow. I know too many people who advance for the sake of advancing, but are miserable in their work. Besides, my wife and I have an 11-year-old and a 14-year-old, I will be working for a long time! Who has been helpful to you in your growth as a cardiovascular professional? My parents, for showing me that diligence and a strong work ethic are essential. My wife, Shay, and our kids, Joey and Ali, for showing me how important a balance between work and family is. And Kristy Wayson, Assistant Administrator of the Heart and Vascular Institute, for modeling leadership and putting up with my mistakes over the past 15 years. Where do you think the invasive cardiology field is headed in the future? This is an incredible time for this area of medicine. The main reason I went back to school in 1974 is because I was convinced that the need for cath lab staff would not exist for any long period of time. I also made some bad stock deals. Well, needless to say, I was dead wrong. I think over the years there have been two major milestones in this field. The first being coronary intervention and the second, coronary stents. Now I think we are at the gateway of the third milestone. This is the fundamental shift from surgical procedures to catheter-based intervention. Think of it coronary stenting, carotid stenting, cerebral embolization, peripheral interventions, embolization for tumor irradiation, and almost anything you can think of. The cardiovascular lab is now a privileging battleground for every type of physician specialty. The opportunities are endless and CV staff are right in the middle of it. What a great place to be! Hold on and enjoy the ride! Dan Scharbach can be contacted at: Dan.Scharbach@providence.org

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