Page 37 - ANZCP Gazette-August-Booklet

TALES OF A POMMIE PERFUSIONIST –
QUEENSLAND CHILDREN’S HOSPITAL
Angela Horsburgh CCP (UK)
My career in perfusion began in 1995, when as a naïve 21 year old I set off from the comforts of my home in rural Derbyshire for the bright lights and big city of Birmingham, some 100 miles away. I had been offered the position of trainee perfusionist at Birmingham Children’s hospital and was super keen and excited, as having previously studied radiography I had decided that this was actually the career for me! Little did I know how foolish I was!!
After 23 years working in the same centre, I was aware I had amassed an enormous amount of experience......but only in one place under the leadership of one person. A little voice in my mind had, for the past few years, been telling me there must be more out there to see, more to learn and different ways of doing things. After several years of being unable to take sabbatical opportunities in Canada and Australia, owing to short staffing in my home unit, the opportunity to work in the Queensland Children’s hospital became available to cover a period of maternity leave. After taking what seemed like an eternity and waiting for permission from the Chief Executive of our Trust, I was finally granted leave to head off down under.
I arrived in Brisbane, very jet lagged at the beginning of July 2018! It was cloudy, overcast, a little chilly and I had just left an ongoing heat wave in the UK with daily temperatures of 27°C!! Not quite what I was expecting! I had managed to secure an apartment in the Kangaroo Point area of Brisbane, surrounded by the river on all sides and next to Storey Bridge and more importantly, the Pub beneath it! My landlady showed me round the beautiful apartment, with huge balcony along with a sauna, gym, 25m swimming pool, tennis court, media room and all important BBQ’s! I had a sense it was going to be a very different life to that I had been living in the UK!
After a couple of weeks of exploring and a little holiday to Moreton Island, I waved my husband off back to the UK. That evening was probably one of the hardest of my life, suddenly I was all alone on the other side of the world, away from all the people I loved and everything I knew and was familiar with. Homesickness hit me very hard.
The following day I cycled the 10 minute route beside the river to work, feeling like it was first day at school all over again. I had a mixture of emotions, excitement as to what was to come, but these were largely overshadowed by nerves and the hopes I wouldn’t disappoint my new colleagues. My new boss was absent on my first week (busy in Japan with Terumo!), but the other two team members made me feel very welcome and showed me how things worked Brisbane style. By the end of the week I was physically and emotionally exhausted. I was missing home, my husband and felt quite simply overwhelmed by all the new information I was trying to absorb. Had I made the right decision....was this really the right thing for me?
Despite my 20 years of experience in paediatrics, I have lived a very sheltered insular life in perfusion terms. I recognised and had familiarity with some of the equipment my new team were using, but it still seemed to come as a massive shock to me anyway. The ways of working and thinking were so very different to those I had been trained and accustomed to, and were much more scientific in approach! I had however had an opportunity to visit Boston Children’s Hospital in the USA a few years earlier and couldn’t help but notice distinct similarities in the ways of working........ was my home unit an outlier in its approach to paediatric perfusion, should we be doing more or taking a different approach??
Thanks to the immense patience and expert tuition of my new colleagues, I found my feet eventually and started to think a little more like a QCH perfusionist. I’m fairly certain at times my new boss must have been pulling his hair out, questioning my ability as an apparently experienced paediatric perfusionist and wondering just how much use I would actually be to them. With increasing confidence over time I hope I managed to contribute as an effective part of the team eventually though!
Cardiac surgery at normothermia was a strange phenomenon for me to feel comfortable with, coming from a centre where cooling is heavily used on all operations, and strongly favoured by the surgeons. Thankfully oxygenators were familiar and once I had learned one circuit set up it was easy to replicate as others were identical but just different sizes! Priming constituents differed as did drugs, feeling alien not to use steroids and mannitol. Then onto the use of NIRS, MUF, and ZBUF in every case......... none of which were ever used in the practice back home.
One of the main aspects I struggled with was cannula selection, although the department had a very detailed chart for reference. Compared to the flow, cannula sizes I considered and were accustomed to in my unit were considered rather generous. I’m still not a convert to the effectiveness of these reduced cannula sizes, especially as in over 20 years I have never needed the use of VAVD to augment drainage with thoracic cannulation. Regardless of your school of thought however, ultimately decent drainage is only achieved when the cannulae are actually put in the right place (much as the surgeons like to believe it is not their fault!)
Anaesthetic interaction was much greater than I had also been accustomed to. Back in Brum, anaesthetics had little involvement in the perfusion side of surgery, we were left entirely to our autonomous selves. Decision making such as required BP, off bypass Hct, pO2 , cell-saving, drugs of choice, prime constituents and whether to use blood products and clotting factors were entirely our choice. It was common place for most anaesthetists to disappear for a coffee break for several hours, or spend hours glued to the delights of the World Wide Web!
SEPTEMBER 2020 | www.anzcp.org 34