Letters to the Editor

¦an American by my own choice, not by chance. Ken Gorski's November 2001 editorial Where were you? What were you doing? Thoughts on September 11, 2001 was a very moving description of his experiences during several of the events that have shaped the lives of our generation. Being only slightly younger than Ken, I too recall the Challenger disaster of January 1986. I was in high school and had gone out to lunch in my yellow 1982 Mustang. Cruising to the sub shop in sunny Miami that afternoon, I heard the news from the DJ at the station I was listening to. As I got my lunch, I picked up several more details about what had happened. Later when I returned to school, there was a very odd silence as students and teachers gathered around television sets that had been wheeled out into the hallways. As Ken noted, it was a day that will be forever ingrained in my mind.  Of course, September 11, 2001 will also be one of those days. Ken decided not to go to the TCT, a conference he'd undoubtedly been to several times. I, however, jumped at the chance to go to a cardiology conference in D.C., particularly since I had never attended one this large. I had not been to the city since I was a child and so I convinced my wife to take the week off and make it a working vacation. I was excited about meeting some of the other cath lab folks from around the country and learning about the new techniques being used. Although I work primarily with children, the meeting promised lots of useful information. We flew into National Airport on Saturday morning, September 8th. I remember being impressed by how close we flew to the Washington Monument. On Saturday, Sunday and Monday we did the tourist thing, going to the Capitol Building, Supreme Court and a couple of the museums on the mall. On that fateful Tuesday morning, we headed out for our last full day of sightseeing before I had to attend the conference which was to start that day. We decided to take the White House tour. The public tour for the White House begins lining up at about 7:30 AM. By the time we got there, it was about 8:30 or so, and we took our place in line behind about 200 other folks. Over the next hour another 200 or so people lined up behind us. Traffic on the street behind the house was rather busy, which I found interesting since Pennsylvania Avenue on the opposite side of the house is closed off to traffic. Then at about 9:50, the 200 hundred or so people in front of us suddenly began running away from the White House. Now, I am no braveheart, but I had stood in that line for an hour and a half and was not going to lose my place. I figured there must be some person with a weapon near the house or a suspicious car or something, and the guards would have it settled in short order and we could get on with our tour, which was important to me. Not until the guards ushered us off the grounds and across the street did we see the smoke from the Pentagon in the distance. Then we started getting scared. Smoke rising over Washington D.C., clearing the grounds of the White House, sirens blaring all around, people frantically trying to use their cell phones it was all surreal. As we made our way back to our hotel, there were thousands of people on the street. Later I learned that they had evacuated all the buildings and shut down the subways, neither of which I thought was such a great idea if we were being invaded. The movie that kept going through my mind was Red Dawn. I was sure we'd be seeing parachutes opening in the skies above us as the invaders moved in. Once back at our hotel room, I realized the extent of what was occurring. We immediately began calling home to let everyone know we were OK and that we had not been at or near the Pentagon. We stayed in our hotel room that night, listening for airplanes. Many flew overhead along with what seemed endless helicopters. Of course, TCT was cut down to one day. A very sad sight the almost empty presentation hall, the rows of empty exhibit booths, reminders of what could have been. My wife and I, however, were stuck in Washington, D.C.  On Wednesday we ventured out to see what was going on about town. We walked to the White House, where black-suited secret service men patrolled the roof and grounds. Everyone, including us, moved very carefully, trying not to look suspicious. It seemed that all the public buildings were closed except for the museums, so we took in some of those that we had missed earlier. On Thursday we did the monument run; often jets would zoom overhead. I actually began to feel safer than ever. A number of military police were parked near our hotel at George Washington University and we took their pictures. It was weird. On Saturday, our last full day in D.C., we decided to go to Arlington Cemetery. We had not ventured across the river because it was so close to the Pentagon and the subway was not stopping there until about Friday. After touring the cemetery, an experience that would undoubtedly have been very different only a few days earlier, we decided to walk to the Pentagon to see how close we could get. They had the road to the Pentagon closed off to traffic and we could only get within about a half mile. But we could see the hole. I think we needed to see this to make it real for us. We could not understand why God had put us here in the middle of this event only as witnesses. Seeing the charred, torn building and then hearing that the flight that crashed in Pennsylvania was probably meant for the White House made us realize how incredibly blessed we were that day. It made us realize that some brave souls on that plane may have unknowingly given their lives for ours. Later, hearing the stories of survivors and families of those lost in the World Trade Center, we began to realize that this event will be with us and the world for a long time to come. I also began to realize the responsibility we as Americans are going to have to bear in decades and centuries to come. This is a responsibility that I began to consider as our plane lifted off from Dulles International and brought us safely home. Yes, our world has been changed. But I don't think that vigilance is all that is called for. I am an American, although I was not born one. I was born in Cuba and have lived all my life in one of the most culturally and ethnically diverse cities in America Miami, Florida. I often pride myself in saying that I am an American by my own choice, not by chance. My parents also knew much, much greater hardship than I ever will. It is because of the knowledge of the hardships my family endured that I believe we as Americans have a responsibility to the people of the world to not only defend our way of life, government, and economy, but to also work diligently with the international community to eliminate oppression, defend human rights and promote freedom throughout the world. On September 11th it was said that the sleeping giant has been stirred awake. Sleeping we have been. And by doing so we have shunned our responsibility to bring America to the world rather than have the world continue to come to America. The political changes of the later part of the 20th century have shown us that the American Experiment is a success and that it will spread throughout civilization, and we have to ensure that it does. That is why the Tomahawk missiles don™t land in America. That is why throughout the 20th century America has been the safe haven to which our soldiers come home. After Afghanistan has been destroyed and rebuilt, after the terrorists have gone the way of the Nazis, and even after the anthrax mailer has been eliminated, America will be here; yes, vigilant and strong as ever. But I pray that we will move beyond thinking of America as this place we live in that belongs to us and think of America as an idea whose time has come to grow beyond its borders. God Bless America and all that she represents. Nestor Ventura Chief Cardiovascular Technologist Miami Children™s Hospital Miami, Florida  USA Dear Editor, This is in response to the September What Do You Think? topic regarding an all-tech cath lab. Our cath lab did not always have RNs working there. When they did, it was usually only one or two in the whole staff. I think that working in the cath lab is very unique, and the RTs and CVTs are very knowledgable and highly trained. I know that they are very skilled in the technical area and also very knowledgable in terms of coronary anatomy, monitoring, equipment, and radiation. Our staff also has a lot of knowledge regarding medications and can function in codes and crisis situations very well. I would want them in my case if the need should ever arise. I think that what has happened over the years is that the acuity of the patient you see routinely in the cath lab is much higher. Twenty years ago, you did a dx, and the cath patient went to the OR or got treated medically. You gave IV heparin and then protamine. If a patient went into v-fib you defibrillated and started lidocaine. Things are not so simple anymore. Patients have multisystem failure, are very high risk, and stay in the cath lab sometimes two to three hours, having multivessel PCI performed. You are giving drugs like epical gtts, dopamine, amiodarone, IV NTG, IV lopressor ¦the list is endless. I do not think anyone means to try and take away anything from techs in the lab and their level of expertise. Our techs do all the scrubbing and the nurses do very little. The techs I work with are excellent and I count my blessings that they are there when things get a little unstable. I think the most important thing to remember is that we are all supposed to be working as a team to provide the best care for our patients. Successful completion of my job depends on the CVT™s or RT™s successful completion of their job. We compliment each other™s roles. We have to work together as one. I think it is important to have an understanding of what is involved in the other roles, so cross-training should be done. The RT is always going to be more experienced in his field, as well as the CVT. I think in order to be an exceptional cath lab employee you have to understand the whole picture. You cannot if you don™t learn about radiation, equipment, fluoro, waveforms, pressures, sterile technique, etc. We can all teach each other a great deal and we should be willing to share our knowledge and expertise with each other. If you do this, you will work together exceptionally well as a team. What is so great about this? Ask your patients. When you work together well, it is very obvious to your patients, and they are the ones who benefit the most. And isn™t that why we are all here? Annie Rupert

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