Interview with Mr. Clifford Ball: a Clinical Cardiac PerfusionistVidhya Natarajan Job Outlook
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On the 19th of June 2010, one of our career researchers, Vidhya Natarajan, spoke to Mr. Clifford Ball, a perfusionist and the Program Director of the Cardiovascular Perfusionist Program at the Cleveland Clinic, Florida. They spoke about the profession and his journey towards becoming a perfusionist. The following is a written transcript of the interview:
Vidhya Natarajan: On behalf of the Journal of Young Investigators I would like to thank Mr. Clifford for joining us today. To start with, our readers would like to know a little about your education.
Clifford Ball: It is my pleasure to be doing this interview today. About my education, I did a four year degree in chemistry first. Following which, I was in a PhD program but dropped that because I did not want to pursue it. Thereafter I worked in construction for many years but then I did not like that, so I was looking towards going back to school. I was considering becoming a pharmacist but then a friend of mine who is an anaesthesiologist told me about perfusion. So, I got into the Cleveland Clinic training program and subsequently joined the staff there. Since 2008, I have also been the Program Director at the Cleveland Clinic. So you see it was pretty simple actually.
VN: What got you motivated to become a perfusionist?
CB: When I spoke to my friend, the anaesthesiologist, he briefed me about perfusion medicine and all the equipment involved. My answer to him was, ‘Boy that sounds boring!’ He said, ‘Oh no! It is pretty interesting.’ I was pretty sceptical actually because I did not know anything about what was happening in medicine as I was in construction for long. Then I went to Cleveland Clinic and observed an open heart surgery and what it took to operate a heart lung machine. I was like, ‘Oh! This is going to fun’ and it has been fun ever since.
VN: Could you please narrate how a day in the life of a perfusionist goes about for our readers.
CB: Basically, we come in the morning and see what cases are assigned for the day. We go to the Operating Room (OR) and meet with the surgeon and discuss the surgical procedure and decide what kind of a perfusion the patient requires and what special equipments/techniques we may need. Then we go ahead and set up the required equipments. After the procedure is done we stand on hand in case we need to go back quickly on bypass. Outside of the OR we have a lot of responsibilities as far as regulation and things that we need to do to make sure our equipment is up-to-date, in good quality and well tested. In my case, I need to run the Department, so I have that responsibility too.
VN: What qualities and qualifications would you look for in a student who would like to be a perfusionist?
CB: Well, the number one quality (which I have hard time figuring out in a student applying to our program) is whether they a have good problem solving technique; this is something people are just born with. To be honest with you, a doctor has two things. They are great memorizers and good problem solvers. You don’t see a doctor unless they are good memorizers but they need not be good problem solvers. In perfusion it is the opposite way around. You don’t have to memorize many things but if cannot solve a problem very quickly then the patient can die. That is what makes our profession different.
VN: What about the research opportunities in the field of perfusion? We would also like to know about the research activities going on in your Department in Cleveland Clinic presently?
CB: Oh, there are a lot of research opportunities and the reason I say that it is an upcoming field with two forms of research. One, there is lot of research on the technique improvisation and on the other hand there is lot of research on how the equipments can be improvised. There are many areas of research that we are pursuing here at the Cleveland Clinic. Our main topics are the effects of giving phenylephrine, the effects of hemoconcentrating and air emboli sources. Other ongoing projects are leukocyte filters, pulsatile flow versus non-pulsatile flow, centrifugal versus roller pumps, cell saver versus pump suction, and further miniaturization of the perfusion circuit.
VN: That sounds interesting. How was the transition from construction to perfusion and how did you handle that?
CB: Well, I loved going into perfusion because it had a lot to do with mechanics and if you are in the construction field, that has a lot to do with mechanics too. This was something I learned in construction that I could very easily apply in perfusion. Where I had my problem was learning the anatomy and physiology of the things I was dealing with. Most people who come into perfusion know the medical side but they don’t understand how the mechanics works. So, it was an easy transition for me.
VN: There has been talk regarding surgical population load coming down with advances in medical management. How do you see the profession in the coming years?
CB: We are going to have more jobs, not less. The population is not getting younger but it is getting older. We have difficult operations to perform on the old and that is just one aspect. The other aspect is that the coming generation is going to harvest artificial organs to transplant. So, the number of operations will go up. Third thing is that perfusion is not a very old profession it is actually very new. What’s happening is that the people who stated the profession back in the 60s are retiring and are looking to go out and we in the United States do not have enough perfusion schools. So, I don’t see the profession going downhill. Though what might change is the thing we do. For example, we are getting into chemotherapy where they can target the cancer cells with particular proteins and hit the markers. There are a lot of things that we can go into outside the cardiac area.
VN: As a last note do you have any advice for undergraduates looking forward to perfusion?
CB: My advice to them is to explore perfusion to see if it is for you. I will be very honest with you. You’ve got to have problem solving techniques. If you are a memorizer then this is not something you will like to do. The other thing is that you must have the excitement of firemen (to put the fire off) or policemen (for chasing). You’ve got to have the excitement of saving somebody’s life where everything is going downhill very quickly. You have to enjoy that stress. If you do not like stress, you are not going to do very well in this. In fact many people go out of this profession in their forties to do research and other things because they are burned out. Try different things in life. Like I did construction and transitioned into perfusion; I think that helped me immensely to have a good understanding of the mechanical or practical side of the field.
VN: Thank you once again for joining us today.
CB: My pleasure.
For further reference you could go through the following links:
American Board of Cardiovascular Perfusion
Cardiovascular Perfusion Forum
“A perfusionist, also known as a clinical perfusionist, is a trained health professional who operates the heart-lung machineduring cardiac surgery and other surgeries that require cardiopulmonary bypass. The perfusionist is a highly trained member of the cardiothoracic surgical team which consists of cardiac surgeon, anesthesiologists, physician assistants, surgical technicians and nurses. The perfusionist’s main responsibility is to support the physiological and metabolic needs of the cardiac surgical patient so that the cardiac surgeon may operate on a still, unbeating heart. This is accomplished through the utilization of the heart-lung machine, as well as its associated components of an oxygenator, filters, reservoirs and tubing. The perfusionist is solely responsible for the circulatory and respiratory functions of the heart-lung machine. In addition, there is a spectrum of physiologic parameters that are constantly monitored by the perfusionist that ensures that the circulatory and respiratory needs of the patient are being met and allows the cardiac surgeon to focus on the actual surgical procedure and less on the immediate needs of the patient. Other responsibilities include autologous blood collection and processing, implementation and management of the intra-aortic balloon pump, adult and infant extracorporeal membrane oxygenation (ECMO) as well as monitoring of anticoagulation, electrolyte, acid-base balance and blood-gas composition. In many tertiary hospitals, perfusionists are also key personnel in placing and managing patients on ventricular assist devices as bridge to recovery or heart transplantation and supporting patients receiving lung or liver transplants. In certain hospitals, perfusionists can be involved in procurement of cardiothoracic donor organs for transplantation.” (Source: http://en.wikipedia.org/wiki/Perfusionist)