“America’s health care workers are on the brink of collapse. If we want them to hold on and be there for us when we are too sick to walk, stand or breathe, we must act now.

Cast aside political opinions. Follow CDC guidelines. Wear masks when you are in a group of people. Remain properly vaccinated. Maintain social distances. And please extend extra consideration to health care workers.

Is that too much to ask to do for someone trying to save your life or the life of your loved one?”

Julie Collins is a cardiovascular perfusionist.

She shares her story and discusses her KevinMD article, “Support desperate health care workers now, before your life counts on them.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Julie Collins. She is a cardiovascular perfusionist. She wrote the KevinMD article “Support desperate health care workers now, before your life counts on them.” Julie, welcome to the show.

Julie Collins: Thank you, Kevin. It’s an honor to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Julie Collins: Sure. Like everybody who tends to want to do something in health care, I didn’t know exactly what direction I wanted to go in. My grandfather passed away from a massive heart attack, and my father had heart surgery, so I knew from a young age that I wanted to do something in health care. I got a bachelor’s in biology from La Crosse, and then I went to perfusion school at MSOE after learning about the field of cardiovascular perfusion and what an impact I could make.

When I graduated from perfusion school, I went and worked on the East Coast for five years, and then ultimately wound up coming back to Chicago, and I’ve been in Chicago for 10 years. I’ve been a perfusionist for 15 years, and for four or five of those years, I’ve been the program director of the perfusion school at Rush, still working in the operating room and in the ICU, taking care of patients as a perfusionist.

Kevin Pho: So I’ve done almost 700 of these episodes, almost two years of shows, and I don’t think I’ve had a cardiovascular perfusionist on the show. So for those audience members who aren’t familiar with what you do, just describe what a perfusionist is. Walk us through a typical day of what you do and see.

Julie Collins: Sure. Cardiovascular perfusionists work primarily in the operating room, and they help the surgeon provide a motionless, bloodless field for the surgeon to operate on. During open-heart procedures, the patient’s blood drains into our reservoir, we oxygenate it, and we act like their heart and lungs during the procedure, and we assist the surgeon with taking care of the patient.

We also run a life support device called ECMO that’s seen in the ICUs and has been well known, and kind of enhanced, during COVID, taking care of these patients who don’t have any other options. So we act like those patients’ lungs to try to give their lungs a chance to recover.

Kevin Pho: So share with my audience, what are some of the challenges and rewards of what you do?

Julie Collins: Sure. When patients come into the operating room, they’re introduced to the nurses, they’re introduced to the anesthesiologists and the surgeons, and oftentimes we’re just the person in the corner with this machine that’s going to keep you alive. One of the things that I enjoy is that every patient responds differently to the procedure, and when you’re on bypass, they all respond differently. So even if you do a CABG case every single day, your patients can react differently.

And so we have the opportunity to be a silent person taking care of those patients. They won’t know who we are. They won’t know that we probably exist or that we kept them alive during the surgery, but we’re able to make a huge difference in their lives. And so every patient that we see is like our mother, our brother, our father, our grandfather. We take care of them like they were our own patients, our own family members, and so it’s an opportunity to silently take care of somebody.

Kevin Pho: All right, so let’s transition into your KevinMD article. It’s titled “Support desperate health care workers now, before your life counts on them.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Julie Collins: Sure. I’m the program director of the perfusion school, so I just work per diem, sitting ECMO patients, and also working in the operating room. After one shift sitting ECMO, in the morning, talking to some of my colleagues, I was particularly struck, because although we had had two other waves of COVID, this third wave of COVID with Omicron was different. My health care worker friends were just overwhelmingly exhausted and too tired to say what they needed to say.

In that day alone, I spoke to one of my friends who had just gotten off doing a night shift, and he said he was lying in the call room in bed, and a code went off. It wasn’t his patient, but he knew the nurses could have needed help, and he was too tired and exhausted, so he rolled over and went back to bed, because he didn’t have the energy to do that and take care of his own patients.

Then, as I was walking out of the hospital that day, I spoke with another perfusionist friend, and he said that he had just put a three-year-old patient with a cardiomyopathy on ECMO who was post-COVID, because the heart was failing from COVID. And so he called his wife to have her take their child to go and get vaccinated. And then I had just gotten done talking to another friend who said, “I just can’t keep watching these people die day after day. I just can’t do this anymore.”

It made me think about the two years or so that all of us have been doing some sort of self-quarantine from our families: taking our clothes off in the backyard, following ourselves through our house with a can of Lysol, showering in the basement so that we didn’t touch anything in our house, to not spread COVID to our families. And for me personally, with my seven-year-old son, I spent two years listening to him, probably every month, coming to me saying, “Mommy, you’re not going to die, are you?”

And so it’s just the fatigue and the exhaustion. Hearing all of these things as health care professionals who are trying to fight against COVID was just overwhelming that day, so I sat down with my computer and I wrote this piece that you published.

Kevin Pho: So from your lens as a perfusionist over the last two-plus years during COVID, walk us through some of the most difficult days. And when your child was asking you whether you’re going to die or not, what was going through your mind?

Julie Collins: Sure. I mean, of course you tell them, “No, everything’s going to be OK. Mama’s going to take good care of herself. Everything will be OK.” But in the back of your head, you’re wondering, because the patients that you’re taking care of are the same age as you, and they’re dying. And you’re the one who’s holding up an iPad tablet so their family members can say their final goodbyes, and you’re the one holding their hand when they’re dying, and you’re the one who ultimately is clamping the line for their life support device, which is leading to them passing away. So it’s definitely a struggle.

Some of the most significant stories: There was a woman who was on for a very long time, and she was my age, and I spent a lot of time talking to her when I was picking up extra shifts. It was just such a relief when she was able to finally leave the hospital, but there were a couple of nights where she coded and we wound up having to do some things to get her back, and I didn’t know if she was going to make it.

And there were two younger people who were teenagers who were both in the hospital, and one of the younger teenagers survived and made it out of the hospital, and the other one didn’t. All of these patients become like your family, and we take care of them for weeks to months, and so losing any of these patients is just heartbreaking for all of our perfusionist faculty and for the nurses and doctors who take care of them.

Kevin Pho: So after you have an outcome that was unexpected, or an adverse outcome from COVID, what did you do immediately after to debrief and decompress? What happened immediately after those unfortunate, unexpected results?

Julie Collins: I mean, to be honest, when you remove support from somebody, usually there’s another patient who needs the machine. So you’re cleaning the machine, you’re getting your body, and you’re putting it on a new patient to give them a chance to survive. And then at the end of the night, when you get home, you think about it, you debrief with some of your friends, cry a little bit, and you realize that that next patient needs you as much as the one who just passed away did.

Kevin Pho: Now, in an ideal world, what should have been done in terms of being able to debrief and sort through these difficult emotions? Is there anything that you wish could have been done further to help you with those feelings?

Julie Collins: I mean, I think the biggest struggle is that patients were dying so rapidly. You would go into the hospital and you would hope that nobody would die and that your shift would go well, but inevitably, more times than not, somebody would pass away, or somebody would have an adverse event happen. Maybe they would have a stroke, or you’d have to take them to the operating room, or they would code and you’d try to get them back, or they would desaturate to a crazy low level, and that was just kind of your routine life. So I wish there would have been more time in between each of these events for you to kind of process what had happened, but it really was just happening so rapidly that there wasn’t time to process or debrief properly.

Kevin Pho: Now, as you reflect over the last few years, and hopefully now things are better than they were, especially during Omicron, how did the last two years change you as a professional?

Julie Collins: I mean, I think it’s made you rely more on your co-workers, because a lot of times you weren’t able to, and some of my co-workers quarantined themselves from their families. So you depend more on the people that you work with to do that debriefing and to help you through things that you’re struggling with, and when you’re frustrated or angry or mad or upset, those are the people that you talk to. I think perfusion in general is a small profession. There are only 5,200 perfusionists in the United States. I think it just brought us closer together as a group.

Kevin Pho: We’re talking to Julie Collins. She’s a cardiovascular perfusionist. She wrote the KevinMD article “Support desperate health care workers now, before your life counts on them.” Julie, God forbid that there’s another wave of the pandemic, and hopefully things won’t get any worse, but now that you’ve experienced the worst of the pandemic through Omicron, how are you better prepared to face future pandemics?

Julie Collins: Sure. I think we’ve all learned a number of lessons. We’ve learned that it takes time to figure out how to treat these patients more effectively, and, if something is happening, to have enough supplies so that you can actually take care of these patients: having enough PPE, and having enough oxygenators and enough equipment to build circuits. I think it’s something that would come to our minds quicker, to make sure that we’re prepared to handle the number of patients that we would need to take care of.

And I would say also just knowing that we have to be resilient and that it will be more work for all of us. We might be doing jobs that are not the jobs that we were assigned to do. You might be the janitor, you might be the person stocking the carts, but just being able to do whatever we need to do.

Kevin Pho: If you were to do this all over again, is there anything that you would have done differently?

Julie Collins: I don’t think there really is a way that you could have prepared for it any differently. If I were to do this again, I guess I would just be more mentally prepared for what I was up against and how to manage taking time for myself, making sure that I was debriefing properly, talking to people when I began to get frustrated with something as opposed to waiting. And also, maybe I’d have a better way to explain to my son what was happening, and that he was going to be OK, and the things that I was doing to make sure that he was OK.

Kevin Pho: Any piece of advice that you could share with perhaps new perfusionists who haven’t gone through what you went through?

Julie Collins: In the perfusion school, in my role as the program director, I’ve been sending the students out on rotation so that they can get more exposure to ECMO, and we’ve also been having more ethical discussions about ECMO patients in the classroom. So my way of preparing them is to have some of these discussions about things that could happen to patients that you’re taking care of, so that we kind of debrief on a made-up situation before they ever have to deal with facing that when they’re an active, working perfusionist.

Kevin Pho: And when it comes to ECMO, what were some of those ethical decisions with ECMO during the pandemic that you brought up with these students?

Julie Collins: One of the things that we struggled with was that you put a patient on, and they’re not getting better and they’re not getting worse yet, but they’ve been on for a month, or two months, or three months, or four months. How long do you keep that patient on when their lungs aren’t recovering, if they’re not a transplant candidate and they’re not getting better, when you have another patient who’s waiting for a chance at ECMO and there’s not enough equipment? So how long do you keep somebody on when they’re not recovering, when you know that there’s somebody else who could recover, that you could place that ECMO circuit on if you would cease support on that patient? So when is the time to withdraw? That’s one ethical issue.

And then we talk about patient decisions and family members’ decisions. Another ethical issue is that we had one patient whose lungs were the best-looking lungs on the unit, but they realized, and they were completely with it, that when or if they recovered, they wouldn’t have the same quality of life that they had before they were put on ECMO for COVID. And they decided that they were done. They didn’t want to be on life support anymore, and we would cease support after the family agreed and the patient agreed. But it was heart-wrenching for us, because they had the best chance of everybody we had on the unit, and they were the one that we would cease support on. So those are two ethical issues we would discuss.

Kevin Pho: So walk us through the path in terms of how those ethical decisions were assessed, from your experience.

Julie Collins: Sure. I mean, with the patient who decided to withdraw support and that he was done, of course there were numerous discussions with the surgeons and with the family to look at outcomes and prognosis, and how he was improving, and if he was going to improve, and what that looked like. And after you educate the patient, you educate the family, and you look at all of the information that you have, it’s ultimately that patient’s decision. So with the students, it was just walking through what pieces of information you have and what the steps are before that patient makes that decision.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Julie Collins: Yes. One of the biggest things is that we’ve seen that patients who are vaccinated don’t usually wind up on ECMO. Patients who are not vaccinated are the ones that we see the most of. And so I guess just keeping politics out of it, keeping concerns at bay, where you look at the actual information that’s being presented and you make an educated decision, because we wouldn’t have seen a lot of these patients if they were vaccinated. I know it’s a personal choice, but just looking at all of the information, and not looking at just one source, when you’re making that decision.

And then realizing that if you’re not feeling well and you’re starting to decompensate, coming to the hospital sooner rather than later will increase your chance of having a better outcome. And realizing that health care workers are doing the best that they possibly can, and that we’re exhausted. We’ve been working extra shifts. We’ve been dealing with patients dying on us for two and a half years now. We’ve had people resign. We’ve had people leave. So just have a little bit of compassion for those people who are taking care of you.

Kevin Pho: Julie, thank you so much for sharing your stories, time, and insight, and thanks again for being on the show.

Julie Collins: Thank you so much, Kevin. I appreciate it.