A Locum’s ScrapBook: Looking in the Rear-View Mirror

FA 2016

Editor’s Note:

To view the entire “Locum’s ScrapBook” series- click here

My life is Family First and then Perfusion.  I switched from staff perfusionist to becoming a Locum’s traveler to make sure my kids and family would have a solid place to call home.  I travel because it puts me in charge of my life, it is challenging, and I enjoy learning new techniques, other ways of doing things, as well as getting exposure to alternate approaches and paradigms.  

I have always been brutally honest when delivering content to this blog.

On this post, however…  I debated on the merits, and decided that you can’t really sugar coat some things we encounter in our profession.  Most of my posts regarding life as a Locum’s have had that positive “spin” that truly is a reality for the type of perfusion persona that this sort of work is cut out for.  As perfusionists, we weigh options all the time: risk versus benefit regarding the choices we make on bypass.  I would be remiss, if I didn’t share the following narrative that describes Locums Perfusion as also weighing out “risk versus benefit” options when engaging new clinical assignments.  The desire to shine and be very successful- as well as be accepted as “part of the team” must be tempered against the potential for a negative personal experiences due to to a myriad of possible permutations.  From my observation?  Nine out of ten  times, negative experiences are linked hand-in-hand with issues of dominance, strong personalities, and control.



Cutting the Cord

Locums is a really fun and exhilarating job, and sometimes it’s not.

Every once in a while you are going to run into a situation that you are not so prepared for – most often it is personalities, then that can be compounded with new equipment, or equipment you may have used before that is so far in the past in terms of when you used it last, that what you need in all honesty becomes a refresher course.

As a Locums, I’ve learned to parcel out what I choose to commit to memory, what is most relevant in front of me in terms of keeping patients alive, the equipment that I may or may not be familiar with, and ultimately the personalities of the staff and the physicians that I engage.

There are preconceptions established for Locums. It’s the elephant in the room so to speak, people want to know what you did before coming here, but at the same time are curious why you’re doing it now, and obviously for very good reasons, they’re going to wonder if there are gray areas in your past or your career that brought you to the point where you are targeted to be their new backup perfusionist.

The way I look at it is- most of the time that you find yourself traveling and going to new clinical sites you can count on having to overcome quite a few obstacles.  Some of those potential bumps in the road  will present themselves as new equipment that you may or may not be familiar with, equipment used 10 years ago and now requires a little bit of a refresher course, or flat out – equipment that you just are using for the very first time. These are all things that you process immediately when you show up at a new site. The onus is on you to not let yourself be afraid to ask questions (that could be misinterpreted as uncertainty or unfamiliarity) about the equipment and the processes that the hospital that you are- in engages in day by day.

There is no roadmap on how to negotiate a new perfusion environment, but there certainly are some prerequisites that I think that everybody should adhere to; first of which is learn how to navigate the operating room. That involves knowing where things are, introducing yourself to the people that you will be working with when you look for those pieces of equipment that you are about to use. In other words, you’re not only navigating new personalities that you encounter at your new clinical site,  but you find yourself having to prove yourself, sometimes to people that you have no clue on whether or not  they have the wherewithal or insight to make an informed and sound assessment of your skill set, your clinical judgment, or how you will react under pressure.

As we all know, perfusionists with a certain amount of time under their belt are expected to be able to adapt rapidly to a new situation. That’s pretty much a given, and certainly well within the range of expectations of what ever client staff or hospital you find yourself engaged in.

What’s interesting and almost counterintuitive here, is the very people you are trying to help, and demonstrate your ability to learn and adopt quickly, may themselves have been mired in this one place for so long that it is almost to the point of inflexibility.  In other words- they have been doing it the same way forever, with repetition comes a certain level of comfort and a level of familiarity that borders on arrogance- especially when a new person shows up- and they just can’t understand why that person can’t do it as easily as they can- and have done- for the last twenty odd years or so.

If you travel, I guarantee that will encounter that.  It may not be all that pretty or have any resemblance to a prim rose path, but it is what you signed up for, so It is incumbent upon you to demonstrate not only a high level of energy to learn how this new system works, as well there is a plate on that playing field that has your name on it.  It is an unspoken expectation that you will be able to perform when you finally do go to the batter’s mound to take the first pitch.

Taking your run at a pitch in a baseball game  is obviously a metaphor and not a construct of how you map out your brand new shiny clinical roadmap.  But there is and should be a 3-strikes and you are out rule.  You need to put it in perspective though, just to maintain your own personal sense of self-worth and sanity… that 3-strike rule swings both ways.

Just be aware that inherent with those high levels of expectations coming from those that are backing you up, your potential colleagues are spending some seriously important time to get you running and up to speed.  They invest in you- and hopefully recognize that your intent to perform well is a reciprocal commitment.

Don’t forget we are all human beings, and that the pendulum swings two ways. Both parties have something they bring to the table that is to mutual benefit or possible risk, and unfortunately there may come a day when you recognize a bad fit for what it is- and more importantly- what it ISN’T.  It’s definitely not in your past- and probably shouldn’t be in your future.

Some thing’s, invariably- are never going to work out.  It usually presents as a complete disconnect in terms of personalities, and puts everyone at risk.  And the second you get a hint of that?  Don’t abandon faith in yourself, just finish what you started, and unless you are a complete masochist- let it go and don’t come back.  It’s easy to say. “well, maybe it will be better the next time”.  From my experience, that is unlikely at best- and a more predictable result will render unnecessary ill-will and more damage to either or both parties.

Rule # 1?  Trust your instincts and your skill set.  The rear-view mirror is good place to leave unpleasant personalities or situations behind.  Don’t run and hide cuz you had a bad day, but at the same time, recognize the limitations in yourself or the people you are dealing with- in terms of confronting whatever crap is being laid in front of you, and if it really sucks and keeps you up at night because you are worried about personality issues or continued BS- then it’s time to go ?.

Adios Amigos.    Just make sure you gave it a 100% and gave it a fair shot.  If you can answer yes to both those questions in the mirror, then whatever decision you make- is the right one for you 🙂

Rule # 2:  If you get blindsided once, let it go- and come back the next morning and smile your way through it.

Rule # #3  Blindsided twice?  Just let it go- and cut the cord.  End of story.