The Ten-Minute Interview with: Dennis R. Chadwick, RCIS, BS, FSICP

Why did you choose to work in the invasive cardiology field? I re-enlisted to be trained in the cath lab for my 2nd enlistment in the Army. I felt it would be a good career choice, but little did I know that I would, literally, fall in love with my job. I was intrigued by and attracted to the fast pace of invasive cardiology and the cutting-edge technology that it employs. I love the team approach, the close working relationship with the physicians and the critical nature of the work we do. These are the things that I like best about invasive cardiology and the things that will keep me coming back to work, day after day. Can you describe your role in the cardiovascular (CV) lab? I have held many roles in the cath lab, from sheath puller (my first job in the lab) to Interim Administrative Director. At present, my role as Technical Supervisor requires me to be involved more with the technical side (equipment, vendors, computer networks, and capital projects) of the cath lab, but I continue to strive to be a clinical leader for my peers and other members of the heart team. I prefer to be a mentor and clinical resource to others within the department and as a working supervisor, it is not unusual to see me in scrubs helping out. What is the biggest challenge you see regarding your role in the CV lab? The biggest challenge to the health care professional within the invasive CV lab remains advancing technology in this ever-changing, fast-paced environment. These technological advances provide many challenges in the area of scope of practice and maintaining competencies for the RCIS. Also, along the same vein, is the fact that reimbursement rarely keeps pace with technology. At present, CMC is in the EVEREST trial for E-Valve. The E-Valve device allows for percutaneous repair of a prolapsed mitral valve, thus sparing the patient the trauma of open-heart surgery. However, reimbursement is lagging behind and most cases cost more than they are reimbursed. This results in having to make difficult decisions on acquiring the advanced technology or denying the technology to the community we serve. What motivates you to continue working in the CV lab? I think the best motivation for anyone who works in the field we do is the gratification of seeing a patient who came to you in cardiogenic shock or had several episodes of ventricular fibrillation (VF) and later see them walk out the door with their family. Who could ask for a better reward? That experience in itself keeps me motivated to continue doing a good job. Also, having a very motivated team of individuals to work with, inclusive of the physicians, nurses and specialists, helps as well. What is the most bizarre case you have ever been involved with? Many years ago our call team was called in during the middle of the night for an acute coronary procedure. The patient was a middle-aged female in cardiogenic shock, had multiple IV drips going and was intubated. After ballooning and stenting both the left anterior descending (LAD) and circumflex (CRX) arteries, the physician asked me if I knew what that strange, moving formation was in the subclavian. It was a huge bubble of air. We inserted a sheath in the right femoral vein and followed it with a multi-purpose (MP) catheter. We manipulated the MP into the subclavian and proceeded to withdraw a total of 60 ml of air. We never knew how the air was introduced into her system, but we were glad that we were able to remove it before it caused harm. When work gets stressful and you experience low moments (as we all do), what do you do to help keep your morale high? I am very fortunate in the great support that I have from my best friend and wife, Nancy. She can sense when I have those low moments and becomes an active listener. Having worked in the lab before herself, she understands how stressful this job can become. I also have another Nancy that is a great supporter. Nancy Lee and I have worked together at Carolinas Medical Center for 12 years and know each other’s moods. So I watch her back and she watches mine. Are you involved with the SICP or other cardiovascular societies? I am a member of the Association of Cardiovascular Professionals (ACVP) and a fellow in SICP. I am a strong advocator of networking. It is very important that we stay connected to our colleagues in the cardiovascular world. Too often, we develop blinders and believe that the way we do something is the only way the task can be accomplished, and that is rarely the case. If we stay connected, it keeps us open to new ideas. I am also a strong believer in the Registered Cardiovascular Invasive Specialist (RCIS) credential. It is the gold standard in the cath lab, as it is the only credential that encompasses all the areas of expertise needed to ensure excellent patient care. Are there websites or texts that you would recommend to other CV labs? There are many great websites out there. Two great sites for late-breaking news in the cardiovascular world are www.theheart.org and www. invasivecardiology.com. I know all RCISs need CEUs, and a way to keep track of them is on www.naccme.com. Do you remember participating in your first invasive procedure? I cannot remember the very first procedure, but one of the early ones made a lasting impression. A female Army staff member had a stress test that was abnormal and she was scheduled for a cath. She was about 34 and in good shape from the physical exercise required in the military; however, she did have a strong family history. The procedure was going fine with no problems; we had taken an arteriogram of the LCA and had proceeded to the RCA. Both arteries were clean and we were about to proceed with the LV when the patient began to complain of severe chest pain. We went back with the JR4 and saw that when the catheter had been removed, the ostium of the RCA had been dissected. We tried numerous balloons but could not tack it back up and there were no stents back then, so we sent her emergently to the OR for a single bypass. That one case will stick with me for the rest of my life because it showed me unequivocally that what we do touches people’s lives in a most profound manner and not to take what we do lightly. If you could send a message back to yourself at the beginning of your CV lab career, what advice would you give? I don’t know that I would send any message. Since I got on the cath lab merry-go-round, it has been a fantastic ride. I work for the fourth largest healthcare system in the U.S. I have worked with world-renowned interventional cardiologists and some of the most technically proficient RCISs in the world. I have traveled all over the U.S., had as my patients famous sports personalities and even met Laura Bush, the First Lady. All the decisions in my career have led me to this point and I am very happy with where I am now. Where do you hope to be in your career when it is time to retire? I hope I will never truly retire, but will continue to be involved somehow with healthcare education. The need for education is paramount and will become greater as our field evolves and changes over the years. We, as healthcare providers, can never stop learning. The more we learn, the greater ability we have to positively impact our patients’ lives. No one individual can possess all the knowledge; that is the reason we are all part of the team. Has anyone in particular been helpful to you in your growth as a cardiovascular professional? Had it not been for the assistance and guidance of three individuals I would not even be in this field. First is Mark Hernandez. He was in charge of the cath lab at Madigan Army Medical Center and it was on his recommendation that I was allowed to train in the lab. Second are Fabio Franconame and Kevin Collier, they took me under their wing and taught me everything they knew, and it was a great foundation. Fabio is a great teacher. If you ask him a question you need to be ready to spend the next 30“40 minutes having it dissected and explained in detail. If you don’t understand, it is not because he did not give you the information. Kevin is a great mentor in cath lab leadership. It is his leadership that has made me strive to attain what I have. Where do you think the invasive cardiology field is headed in the future? I believe invasive cardiology will take a more aggressive role in patient care by replacing more and more surgical procedures. Percutaneous valve replacement and septal closure procedures are just the beginning of this trend and they will become commonplace, just as stenting has. Also, angiogenesis will help those with ischemic myopathies and statins will have slowed the progress of atherosclerosis. I believe that licensure of the non-physician staff in the cath lab is inevitable and that the gold standard is the Registered Cardiovascular Invasive Specialist certification obtained through Cardiovascular Credentialing International. This needs to be upheld across the country as the standard to which all cath labs should adhere.

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