My First Year in Electrophysiology: What Have I Got Myself Into?

Richard B. Fish, RRT Electrophysiology Technician Orlando Regional Medical Center Orlando, Florida
Richard B. Fish, RRT Electrophysiology Technician Orlando Regional Medical Center Orlando, Florida
If an EP lab advertised for an EP tech job opening that read “Wanted: Motivated individual who can stare at a monitor of irregular squiggly lines for up to 10 mind-numbing hours, able to stand for hours wearing a heavy lead apron that puts you at risk of having permanent back problems, all while exposing yourself to cancer-causing radiation,” who in the world would respond? Who would say, “Hey, that sounds really good”? Well, that person would be me, and the following is the story of my exciting first year in EP. It has been nearly two years since I joined the EP lab at Orlando Regional Medical Center, although my career in the medical field really began 16 years ago in respiratory therapy. Orlando Regional Medical Center is part of a community-based system of hospitals in Central Florida where I live. The scope of practice in our EP lab includes EP studies, pacemakers and biventricular defibrillators, and also a full range of ablations. Our team consists of seven electrophysiologists. Most practice in all areas of electrophysiology. A good friend and former colleague in respiratory, Mike Giddings, transferred into the EP lab several years ago. Every time I encountered him, his enthusiasm for EP was unmistakable. Eventually, he began suggesting to me that I should consider the EP department. At that time I had no intention of leaving my current position in the respiratory department. Having seniority and a comfort level that comes from years of experience would be hard to leave. However, Mike was relentless. Maybe he wanted a friend to work with or maybe he saw something in me that I didn’t see in myself. He was convinced that I should come to the EP lab. I was equally unconvinced. Ultimately when I did not respond, he would pass me in the hall and just shake his head in mock disgust. Eventually, he caught me at an opportune moment, so I decided to give EP a second look. Lisa Kearney, manager of the EP lab, set me up to job shadow with one of the lab personnel. I watched the physician and staff perform a couple of procedures and thought to myself, “This doesn’t look too tough.” The EP lab techs, nurses and physicians worked together like a well-oiled machine. Shortly thereafter, Lisa offered me the EP lab tech position. It was a difficult decision to make, but I decided to go for it. After all, how hard could this be? I made the leap and joined the EP lab. Surprise! My first week in EP deteriorated into a blur of confusion. I was in way over my head. There was no way I was ever going to comprehend what was going on. The equipment, the procedural steps, and the terminology were overwhelming. I went home each day with a splitting headache. I was having second thoughts and was regretting my decision to leave the comfort zone and the familiar daily routine of my former job. Nevertheless, I had made a commitment to my new boss and myself. I would have to stick with it in spite of the rising flood of doubt. There were momentary periods of understanding and optimism, but the frequent challenges and difficulties of comprehending this new world were always present. For the first six months I found myself completely and totally mentally exhausted by the time I got home from work. I would often need a nap before having dinner or interacting with my family. Some days I would immediately go straight to bed for the night. My two main preceptors were Sarah Powers-Sharma, RCIS, RCES and Marti Stivaktas, RRT. Marti rewarded my slightest progress or success with great enthusiasm and much appreciated praise. For example, if Marti asked me what the fast pathway was and I answered, “It’s the one that’s not slow?” I could be assured of a hearty pat on the back. She was a great boost for my sagging confidence. Sarah, meanwhile, always answered my questions with another question of her own, which both challenged me to think and dig deeper. Both approaches were exactly what I needed. I cannot thank them enough and am greatly indebted to both for their help, patience and guidance. From the old saying that, “It takes a village to raise a child,” so does it take an entire EP lab to train a tech. Everyone has a hand in bringing a new tech to be a fully functional member of the team — all hands played a major role in my training. Gaining the trust of the physicians during my first year was a major challenge to say the least. I always had the gut feeling that they had one eye on the patient and one eye on me. Our chief of cardiology and electrophysiology department medical director, Dr. Aurelio Duran, is a physician with whom I spent a great deal of time while scrubbing for cases and during monitoring studies. Always generous with his suggestions relative to my technique, I am sure I pushed his patience to his limits and beyond. If he said, “Oh, dear” or “Oh, my” while stepping back from the table, it was a sure sign that I had done something incorrectly. The result was that everyone in the room simultaneously stopped what they were doing to stare at me. What followed was a moment during which I wanted to be a thousand miles away or at least anywhere but right there. A humbling experience, indeed. My lowest moment happened during a Bi-V in which I was scrubbed in with Dr. Peter Taylor. I was having an incredible amount of difficulty handling a long guidewire in my inexperienced right hand and a $3,000 Bi-V lead in my shaky left hand. What happened next is still a mystery to me. I was attempting to position the guidewire inside the Bi-V lead when my unsteady hands lost control of the guidewire and the Bi-V lead shot across the room, quickly followed by the guidewire uncoiling like a spring and flying off in the other direction. Dead silence prevailed for the rest of the case. I felt as though the thermostat was set on 90 degrees. I am quite sure I was the only one in the room sweating bullets. Yet despite all my despair, EP started to make sense. The pieces of the puzzle began to fit together. Slowly but surely I began to become a functional member of the team. That feeling of helplessness and uselessness was beginning to fade, and was replaced with a sense of accomplishment and confidence. More than anything, I wanted to be a fully contributing member of the team. I knew I had a long way to go, but I was feeling as though I now finally belonged in the EP lab. With the exhaustion of the first six months now behind me, the lab was beginning to feel like home. I was no longer looked upon as that clumsy newbie. Recognizing and calling out the arrhythmias during procedures became an increasingly routine activity. Pulling equipment for cases became less of an adventure for all involved. Now the scrutinizing eyes of my colleagues could focus on something else besides me. What a relief! Over time, my fear of the unknown was being replaced by a thirst to understand more. I read articles and studied electrograms in my spare time. My questions gradually became more specific and the answers more clearly understood. The path of any EP tech is a long and arduous one. While some arrhythmias and pathways seem to make sense, others still continued to confuse me to no end. I accepted the fact that no matter how much time and effort is put into understanding these arrhythmias, there is always more to learn. The motto that says, “patience is a virtue” sums up the attitude necessary for survival in understanding our line of work. Now as I near the anniversary of my second year in EP and reflect on the recent past, the future looks more promising than ever. While I still struggle with some of the more complicated scenarios that occur from time to time, they are taken in stride. The frustration of not understanding has subsided, replaced with the reassurance and confidence that some day all of this will be clear to me. The lab expects more of me and I expect more of myself. Training of the new hires with my participation means that I am no longer the low man on the totem pole. Other newbies have taken my place in the ongoing struggle of becoming a functioning participant in the crazy world that exists inside the EP lab. Knowing what I know now, would I do this again? Absolutely. In the medical industry, electrophysiology remains one of the most exciting areas in which to work. The technology and advances that are heading our way can only make those of us in electrophysiology feel as though we are witnessing the most cutting edge advances in any area of medicine. How fortunate and thrilling it is to be a part of this. Recently, I have begun assisting the physicians in the very technical area of mapping. This has impressed upon me how talented and well trained our group of electrophysiologists are, and how appreciative I am of my manager, Lisa Kearney, and Michelle Sperry, the supervisor, for giving me the opportunity here and for showing confidence in me. There is never a dull day in our labs. I am fortunate to work with a great staff, all of whom have a great sense of humor that help to make the long days and long cases much easier than they would otherwise be. My goals for the future are to successfully pass the RCES exam and IBHRE electrophysiology exam. Lofty goals from where I am now, but I believe this should be the desired goal and reward for anyone working in this field. Attaining these credentials would be well deserved for anyone who has put in the time and effort. I know I’m not going to get there overnight, but I’m hopeful that I’m going to get there someday. After all that I went through my first year, why in the world would I want to stop now?