Is There a Metaphor for SILENCE? #PerfusionToo

Readers Comment:  “This is so necessary to discuss in our very small community. There is strength in numbers and unfortunately most perfusionists can easily find themselves isolated and feeling alone in their situation. Thank you for bringing this topic to light.”

Editor’s Note:


To our Readers:  Plz bear with me.
I don’t beat dead horses or a drum too often.  Repetition sucks.  But repetition is what got me to decide to write about this topic- as uncomfortable and sticky as it seems.  This blog is about CV surgery and the people that dedicate their lives to it.  It was designed to teach, share, enlighten, and yes- confront whatever fears lie in front of us.
IMO- The most important things I have ever injected into my writing- are the vibrancy of life itself, the extreme honor we have been allowed to exercise in order to ensure its continuation,  hope, love, and yes courage.  It is THAT courage that I am putting myself on the line for- to at least make a position statement on the behalf of all of us.  ABUSE in whatever form- has NO place in our operating theater.  Period.  Please bear with me- the survey I am asking you to fill out- is your own position statement, that the hearts of our patients can be fixed- but NOT at the cost of our own…
We are so amazingly proactive when it comes to patient safety… 
  • Are we silent when our Q is low- or our venous return sucks?
  • Are we silent when we anticipate a potential stroke window- and transfuse the patient?
  • Are we silent if there are issues with the pump- or a failing oxygenator?
  • The point being:  We save others- But NOT OURSELVES
  • We keep taking the same crap day after day- it takes a toll…  It takes a toll.


To make sure I wasn’t “obsessing” too much on this subject- I went to a sane friend of mine- an ICU BSN for whom I have huge respect-  Dialogue as follows:


“What do u think of the push? Too much- or necessary?”


“I dunno… As a seasoned nurse I ignore it and just move on, and generally blame the physicians imaginary menopausal uterus haha but it would be much more beneficial to patients if all the members of the healthcare team felt as if their opinion or observations were also important… Education tells us to step out and be advocates, but that’s not easy when the person you need to go through is being a big dick”

Frank Aprile, I commend you for posting this and developing a survey. Thank You. As usual, your writing is stellar: bold, relevant and from the heart. Your experience is articulated into a project to motivate all of us to make a difference for ourselves, for others, for our profession and therefore our patients. Thank You.

And further affirmations that it’s ok to make a stand:


Frank, I love your posts, as always. And it’s nice to see some of the more recent posts about dealing with bad behavior. Keep it up – I’m sure that even if many don’t comment or share, you’re making a difference by having this open forum so that fellow perfusionists don’t think it’s just them and they have to deal with that!  Yes, certainly you can print it out. Love what you do. You are making changes in a good way!


The reason I just deleted my comment is because I’m a perfusion student being bullied by my professors actually all 18 of us in my class are. You have no idea what they have done to me and my classmates. Or maybe u do. Think your worst bully times a 100. I know why they are doing it: to put Pressure on us so we will not fall apart when surg does it to us.

But this kind of pressure does not help the learning. In fact I feel I never have learned so little while studying so hard.


 Frank Aprile  if it wouldn’t pay more than an average job nobody would want to stay in a job where abuse is frequent. Apparently there is already a shortage of perfusionists, why do so many quit? Is it really because they’re all retiring? Or might the abuse be a reason?


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I began working in Medicine at 18 as an EMT, then worked my way up to United States Navy Hospital Corpsman, got attached to the Marines for a bit, trained as a surgical 1st assist- and then entered into Perfusion.
I have lived through the slow evolution of of staff physician relationships, back from when Nurses were required to wear their Nurses hat and stand up when a physician entered the room, to now, where where rules of engagement have softened quite a bit, to allow some first-name-basis relationships to form, and the stark professional class distinctions have become less garish and somewhat muted to adjust to the times.
What hasn’t changed however, is the freewheeling temper tantrums, and sense of entitlement that quite a few physicians still carry on their shoulders, and whether they realize it or not- they can really have a negative effect on their subordinates and staff. This is particularly endemic in the Operating Rooms of not only the United States, but prevalent in the hospitals and clinics of every country and culture. This chapter is an effort to highlight this type of “blue blood” mentality and the many forms it manifests in the Operating Room environment.
What is abundantly clear, is that the employee rights movement that is championed by Human Resources Departments in all major businesses and is designed to protect workers from harassment or intimidation of any shape or form, fails miserably to protect healthcare workers from being preyed upon by the ill tempered and unfettered Captain Ahab’s in our world. Behavior that would get administrators, managers, and even CEO’s fired in the business world, is either ignored, swept under the rug, or blatantly tolerated in the world of medicine- especially the operating room theater.
The forms of intimidation or harassment I personally have observed or had related to me- by a colleague or peer- are as follows:
  • Surgeons yelling and screaming.
  • Surgeons throwing instruments
  • Surgeons being warned that audio recording devices would be placed in their operating rooms as a behavioral deterrent
  • Surgeons throwing people out of their room
  • Surgeons barring people from their room for up to a year


  • Forceful sexual Intimidation:  “If I wasn’t married- and you were my religion- WE WOULD HAVE A PROBLEM”  That encounter and direct statement was pressed up on the backside of a female perfusionist against a scrub sink…  Who the FUCK does that???  What Key or circumstance   or sense of entitlement could allow such an encounter to get to that point?  It is uncommon- and I was surprised it was shared so readily.  I have no idea how many others there are out there – in the same boat- like fish in a pond- waiting to get shot or hooked.


Here is a story- I was afraid to tell because I was worried the surgeon I am referring to would read it.  So I guess I was hiding behind the fear of repercussions, because I actually like and respect the man a lot.  Sometimes people just don’t know how their actions impact others?  In this case- I really hope so.
You know what really sucks?  When a surgeon treats visiting students or observers on a totally different plateau than how they routinely treat their staff? That was starkly evident today. This particular MD mistakenly turned around and thought the person he was addressing was a scrubbed in visitor- when it was actually one of our own- a scrub tech that is 100% committed to doing the best job she possibly can. Whatever his comment was- it was coddling and nurturing… Everyone laughed- because the sad truth was- he would have never been so kind to one of us- Everyone laughed because we are beaten down- Stockholm Syndrome- look it up.
The group laughed, although the inequity of the moment wasn’t lost on anyone. People are just too afraid or cowed or beaten down to suggest that they are in an abusive environment. It’s really pretty sad. It’s repulsive honestly- that a professional group of Nurses and Clinicians- can be so beaten into subordination and submission- that they are forced to use humor in order to deal with such an inhumane expression of indifference- and total failure to recognize that the entire crew that works with him- works under the fear of angry and unwarranted attacks. realizing that it’s not a matter of IF- rather a sickening anticipation of WHEN these sort of surgeons lose it and take it out on one of the staff. The natural instinct is to align yourself with the surgeon, and try to deflect with humor- eventually that leads to a pack mentality that will prey on whatever victim just made a mistake or pissed the surgeon off- albeit a member of the team.
Its scary. After the case and the surgeon has left- we talk about anything BUT- the elephant in the room- instead we try to cover the bases by trying to smooth over whatever crap we dealt with, when it’s “just us”. Now if that doesn’t scream ABUSE then what does? We are either relieved after the case that the surgeon didn’t flip out on us- or we re-live- the most untoward moments of the operation- and how bad it got- or what tweaked the surgeon- at what particular time. We cover up by laughing about it- BUT IT’S NOT FUNNY. It’s totally embarrassing- we are professional adults- in a very rare and elite arena- with families- and instead of worrying about our kids (that due to our schedule- we don’t see OFTEN enough) we become like children, and ruminate and re-live the needlessly dramatic moments we have just been forced to endure… It sucks.
At the end of it all- we revert back to those scared little children on the playground when the big bad bully rooster rears it’s head.
How Pathetic are we now?
I have pumped at 48 hospitals- the story never changes- same metaphor- SILENCE.

Anonymous Responses: Ripping off the band-aid …


  • I was put in a situation with a male coworker where he was able to RAPE and physically beat me in my own vehicle and then use it to hold over me so I couldn’t tell anyone. He was best friends with my boss, and would intentionally lie/create situations to ensure I was seen as a failure. My own boss was emotionally abusive due to this. He was so cruel, so mean that before I finally quit- I considered suicide. It was truly that bad. I didn’t even know who I was anymore.


  • Boss would verbally abuse juniors (self included) in OR . I confronted him in his office and bluntly stated that he would get a taste of his own medicine in public. Abuse stopped . I progressed in my field and left after 8 years to start my own center


  • I went to human resources. I was placed on a PIP that was totally subjective; after discussing it with an employment attorney who called it a shameless ploy to create a paper trail, I quit
  • I quit my job & took early retirement due to the treatment of one of 4 emotional abusers.


  • The MD who attacked me professionally & personally is supposedly a pillar of the community and cultivates a holier-than-thou persona. He utilized a patient of his to send e-mails to my boss, other people in the office and other MDs questioning my competence and said that “something is wrong with her”. What was wrong with me, in his eyes, is that I didn’t fall head over heels in love with him. He’s on his 4th marriage and feels he’s god’s gift to humanity. I ended up quitting because the stress was just too much. Nurse’s bully too but doctors hold all of the power and they know it. Once you’re a target, they don’t stop until they make you cry so you’ll be fired for incompetence, or they make you quit. BTW I’m an RN/Administrator with 15+ years of experience


  • I Resigned
  • I quit and moved my entire family.


  • Made to feel incompetent and worried about being fired because of my gender by a cardiac surgeon that was backed heavily by admin. Several staff he brought to the hospital commented “dr xyz does not like female perfusionists” A sales rep said “boy I feel sorry for you girls and the way he treats you” as the sales rep witnessed how this dr was treating the female ccp on the case that day and this rep was making money with a new account and still saw the truth about the doctor…met a perfusionist that had worked with this dr during his training and confirmed “dr xyz is harder on female perfusionists” I voiced concerns with the periop director because our perf dept was 80% female…her response to my concerns was basically keep quiet or you’ll be accused of slander…It is mind boggling that this behavior is tolerated in 21st century healthcare.
  • I have been a ccp for almost 28 years and I have worked with many cardiac surgeons. It seems as though these tyrannical cardiac surgeons are more of a recent development and are more the norm than exception. I never encountered these beasts in the first 21 years of my career. I remember the days of respectful surgeons that valued perfusion’s contributions and input regardless of their gender. I miss the days of working with these charismatic surgeons that inspired you to want to do your best instead of beating you down because of your gender or personality conflicts or any other lame reason they have. These difficult surgeons are workplace bullies and they are creating hostile working environments and it is tolerated by hospital administration. Maybe joint commission needs to look at this and how it can influence patient outcomes. They should be looking at this sort of thing and not worry about what kind of scrub hat is worn in the OR. I wonder how a patient would feel about their physician if they knew how they acted when the gown and gloves go on.


  • Eileen Heller-Stading There is so much more of this that continually goes on….. and some think it is a right…of some sort. You may just be scrapping the tip of the iceberg…


  • Thank you….can’t wait to see the results.


  • It’s something that has always bothered me that the abuse by physicians are just accepted with a ” well that’s how they are” attitude. Hopefully the results of this survey can lead to sonething bigger, forcing some introspection. Unfortunately untill administrators and joe public stop treating the as gods feeding the complex, I don’t see a change soon.


  •  I honestly feel that the perfusion contract company mentality has given many physicians the green light to degrade and belittle perfusionists. I have been told of several instances in which there were conflicts between surgeon/perfusionist at contract perfusion hospitals. The answer to the conflict: terminate the perfusionist to appease the surgeon and keep the account. It’s incredible how difficult it is to be a practicing perfusionist today. Many are treated as disposables despite the looming perfusion shortage. The short staffing is passed on to the team to suck up with no compensation and no work/life balance. I’m hoping I can survive the few years I plan on working.
  • The job is inherently stressful enough without adding the layer of verbal abuse and feelings of disrespect. Lately I went to surgeon to discuss an applicant for new position. He told me he’d give me ten seconds to tell him.


  • Hannes Engelbrecht Glad someone has brought this to light. Currently working with a fantastic team/family, differences are addressed in a respectful way as equals. Over the years I have worked with some people that I wouldn’t want to work with again even for double the salary. Some argue it’s because they are stressed and care about the pt wellbeing, though I would bet my lifesavings that more often than not it has in some way negatively impacted the pt. Especially with juniors or “lower ranked” roles in theater I have seen people hiding mistakes by not speaking up, because, although they are not at fault, they will get verbal abuse due to frustration caused by often a small but important problem eg. Air in venous, accidentally contaminated a product while opening. High line pressures, cannula positioning etc


  • The government fails victims just as much as the rest of society. I took all of the correct measures to ensure the proper consequences for the rapist. Immediately called 911, went to hospital and got rape kit, pressed charges. I was treated as the guilty party by the grand jury. Questions were asked as to find my motive to “ruin this guys life.” Such as have I been to counseling and did I have a boyfriend. He was ultimately found not guilty. He couldn’t say it didn’t happen because of the rape kit. He said I wanted it and they believed him over my story, obvious signs of fear, and tears.


  • I had a female chief perfusionist that constantly talked down about me and made comments to other staff about my family, children, marriage, etc. She claimed I was jealous of her but in reality she must have been jealous of me. Her reputation in perfusion is well known and I have never heard anyone say one nice thing about her except for the two women that are her brownies. I’ve heard about her wrath and lack of professionalism from many perfusionists.


  • Long term abuse by particular surgeon and particular anesthetist who intimidated the entire team around them.


  • I kicked a trash can across the room after a surgeon yelled at me one time. I told him I was turning off the pump sucker since protamine was more than 50% in. He yelled at me saying HE WOULD TELL ME WHEN I COULD TURN OFF THE SUCKER! He wasn’t even using the sucker at the time and there was not a bleeding problem. He told me to turn it off 5 seconds later.


  • Transferred to another academic hospital in Capetown. Fantastic team, where everyone is treated with respect and differences are addressed in a professional and positive way to maintain the good team spirit in our cardiac theater
  • I was planning to work 3 more years but I really can’t stand my job anymore. Trying to hang on for another year. Can retire anytime but financially best in 3 years. I may have to scale back financial quality of life due to being unhappy at work.


  • You won’t find many comments here simply because the Medical Profession does not condone or encourage speaking honestly. I no longer have the sword of Damocles suspended over my neck waiting to snuff out my Professional life as so many of you do. Although, I’ve never let that threat tie my tongue during my career, I will respect the right of others to remain silent. First, I’ll state what we all know. Cardiac Surgery is a tough business. Surgeons, Anesthesiologists, Perfusionists, Scrub Tech’s, and Nurses are all under enormous stress from the need to approach perfection on a daily basis. Those demands are requisite, and anyone who has pursued any of the aforementioned Professions knew the demands on entry to the Profession. When the life of a patient is dependent on exacting execution of tasks, there is little room for error. I have, on occasion, seen those who are not up to the task and quite honestly, do not belong in such a demanding environment. That includes all of the Professions I mentioned above. However I have to say that, for the most part, all of the Professionals I have dealt with during my career fell within the boundaries of competence. But NOT all! This begs the question. What is suitable behavior, including speech, when the performance of a team member is not up to expectations? I was fortunate to have worked with individuals who were excellent in capability and comportment. I was also cursed with having to work with those whom I believe had no business being in an operating room, regardless of their Credentials. Dr. Cooley had a wonderful saying, “Just because you have track shoes doesn’t mean you get to run in the race”….I couldn’t agree more. Interestingly, those who demonstrated excellence were also the ones who capably handled any untoward events during a procedure without losing their cool. They had “the right stuff.” That doesn’t mean they never elevated the tone of their voice to highlight a sense of urgency. It means they never crossed that obvious line that is apparent to all, and engaged in derisive, insulting, demeaning verbal and very audible attacks on the intelligence or capability of other team members. Unfortunately there were a minority of Professionals who did cross that line, and I never understood how that behavior was so easily accepted and allowed to be repeated over and over and over. Institutional politics plays an enormous role. Tradition and culture even more so. Many a department has had a plethora of high performing individuals who simply have resigned and decided to work elsewhere rather than risk being placed in a room with a Surgeon who, from the beginning to end of a procedure, engages in personal attacks, insults and disrespectful behavior. The behavior of that type of individual, no matter how skilled, results in a steady turnover of other team members which negates any advantage his/her technical skills offer a patient. Make no mistake, turnover hurts patient care and outcomes. This behavior is not limited to members of the Operating room. For Physicians, It begins in Medical School and continues through Residency and into Practice. Other Professions, model the Physicians that they have worked with who exhibit this toxic behavior and become the vectors that make it self perpetuating until the entire Medical environment has a degree of contamination, and if not corrected becomes part of the Institutional genome. So, what does one do? First, no matter which rung you occupy on the Professional ladder, you are not helpless. You have recourse and you must set aside your fears and recognize that inaction will only sentence you to a work environment that is worse than unemployment, it literally may cost you your health, sanity, or life. Fight back! Secondly, a greater emphasis on cultivating a team environment in Cardiac Surgery is desperately needed in some institutions. The medieval hierarchy that persists in some Institutions where the all too frequent form of communication is sarcasm and insults needs to be snuffed out with the urgency one would take in isolating and attacking a lethal virus. Because the results are no less deadly. The term “disruptive” has become part of the vernacular of the business world over the recent years. Are any of the Professionals in Medicine really happy with what they deal with on a daily basis? Some of you are, but far, far too many are living lives of dissatisfaction and frustration. So many of you really are the best and brightest, and collectively you have unrealized power to alter the present trajectory of Medicine. ROCK THE BOAT!….become disruptive.


  • One surgeon that I worked with blatently would degrade anesthesiologists and Perfusionists. He would make racial comments, be passive aggressive and generally demeaning. I chose not to work at that hospital long term. The surgeon was eventually terminated for bad behavior.


  • Don’t engage or participate in the bantering


  • Admin in hospital I work at is afraid surgeon. Surgeon is recovering alcoholic and uses it for excuses. Surgeon needs a month long attitude adjustment camp


  • When I was doing vacation relief at a hospital, it became clear that the surgeon wanted to test me to see how much abuse I would take. I told him that I would be working with him for the next month and we could work together as team members or we could work against each other. But that we still had to work together. He started treating me appropriately from that moment forward.


  • Took mindfulness training and psychological self help to try get my own head around work stress and abuse. Was of significant help in easing my own psychological trauma.


  • Not all surgeons/doctors. Many are very pleasant. Just a proportion of bad apples.


  • Surgeon enjoys being the saver of the day. Sets every one up for failure with psychological b s questions only to make himself look better smarter or let’s people have when they have no answers or gives the wrong answers
  • I have worked in hospitals where doctors acted like they we’re entitled. These in hindsight, were insecure people. I currently work at a hospital with very intelligent, professional doctors. We are on a first name basis and treat one another with respect. I recognized a good team only after working with bad teams.


  • Surprisingly the individuals deep down inside are very nice people but could be incredibly abusive and bullying in the work situation and worked in tandem in their approach. I can understand their levels of stress and demand for perfection but then aren’t w we all under those demands. Fortunately I am essentially retired from this now. Suggest you look up Dr Fridays studies on our Profession he did in 1970’s and 80’s.


  • I helped to recruit a Director of Perfusion because I was not able to handle the passive aggressive behaviors of a perfusionist I had hired. The director then hired another perfusionist who was his “best friend”. He and the other team member were trained at the same school. We had differing opinions of perfusion practice. Rather than discussing differences and coming to a consensus based on the current literature and AmSECT Guidelines, I was ridiculed for my practice and ganged up on by the “boys” they brought the male anesthesiologist in on their theories of low flow perfusion and heparin concentrations being hogwash. I was made the outsider and the constant recipient of passive aggressive behavior and belittled repeatedly. The Director finally left because he could not get me fired. The passive aggressive behaviors still persist by the perfusionist I first hired who is also known for his immaturity at the work place and for getting another allied health professional pregnant and on going drama of their on again off again relationship. There are stories I could share from my past experiences, but those are over and this is the current problem. I am 59 and never dreamed I would be experiencing this.


  • Hear what the surgeon said about you during case from those scrubbed in at the table.


  • I left this job of over 25 years…took pay cuts, financial set backs, living away from family, all to escape this surgeon.


  • I quit. Moved to new job and left my family and dream home.


  • I find the verbally abusive and belittling surgeons are the fakiest. The down to earth genuine compassionate physicians are the most dedicated and selfless physicians and have the innate quality to earn the respect of the other members of the team just by being themselves.


  • We would get students and other guests to observe surgery….the surgeon had a routine of starting up a conversation with leading question to “feel out” the persons willingness to have a sexual conversation. Often very graphic and suggestive talk, but never medically based on the surgery being observed. Purely entertainment for the surgeon, anesthesiologist and certain team members. If the person was unwilling to participate, they would be ignored…..but sexual conversation would be carried on and the guest had to stand there and endure this embarrassing and intimidating gutter talk.