Featured Cath Lab Pro: Vivian Tamara, RN
Vivian Tamara, RN, is an angioplasty specialist at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY.
How did you get your start as a cath lab professional and what are you doing now?
My first introduction to the cath lab came when I was working at Lenox Hill in the progressive care unit. I wasn’t working in the cath lab, but we would have patients undergoing catheterizations. About 5 years later I moved to the cath lab and became the clinical coordinator. In 2006 I took a job at Columbia as the cath lab clinical coordinator there. But while I was working in management I found that I missed patients and patient care, so I decided to try scrubbing and became an angioplasty specialist. Now I work on all the different procedures that we do, from regular PCI to working with the structural heart team in the cath lab and the OR. I also coordinate training for our fellows and new angioplasty specialists.
What part of your work do you enjoy most and why?
I love structural cases and high-risk PCI cases. With my nursing background I feel that I'm a good asset to be in the room with the patient, because I bring an additional level of patient care to my role. What I enjoy about those cases is that they are high energy and there's always a lot of decisions and discussions going on, with everyone thinking on their feet. Yes, they can be difficult and stressful at times, but they’re also very fulfilling on a professional level because I can use everything I know to help that patient stay safe from the time we start until they leave the room.
Are there any tips and or tricks that you’ve learned over the years that you share with others on your team or on other teams?
Everyone in the cath lab plays a vital role, from housekeepers to nurses, managers, doctors, ancillary staff, researchers, PAs/NPs, and angioplasty specialists. For others in my role I would say to keep in mind that we are not only there to flush catheters and prep devices. Sure, we should know how to do those things very well too, but that’s not all we should be doing, unless that's all you want to do.
Someone once told me: if you're standing around doing nothing, you should be doing something. I know that sounds cliche, but that is how I work every case. It’s important to always be engaged and be listening. Listen to the physicians so you can be ready to help out when they need you. Being a true member of the team means you should be aware of what is going on at all times both with the physicians and with the patient. Listen to the patient so you can respond quickly if they are complaining about something or need something.
Our technical skills are things we practice and do over and over again in each case in similar ways. But all patients are different, and one thing that I think can be very helpful is knowing as much about your patients as you can before you go into the procedure. For me that means taking time to review their charts and their past procedures before we start. We all have eyes and ears to learn and pass on information that may help someone in the future. We are all part of a team that is there to help each and every person that comes on the cath table.
Could you ever had imagined when you first started out in this field that you would be doing some of the things you do every day now?
No, definitely not. Things have changed so much in the last 20 years. Technology has improved, the complexity of the cases has increased, and physicians are more open to trying things that have never been done. The other big difference is all the research and the clinical trials that were begun years ago when interventional cardiology was fairly new have really come to fruition. We see the results of that research every day in how we approach our cases and the technologies that are being used. Things are more streamlined. Patients are benefitting from cutting-edge research, and those of us caring for patients in the cath lab are constantly learning new things as the science evolves. It’s a field that is certainly never boring, that’s for sure.
Has there been a meaningful case or patient interaction during your career that has stayed with you?
Yes, there was a woman with a blood-clotting disorder with whom I had a special connection. She had been a patient with us several times and always requested that I be in the case with her. The third and last procedure she had was the most difficult. We were all on alert because things were going badly and futility was discussed, but her physician did not want to give up. The surgeon was called and her chest was opened and her heart repaired emergently right on the table in the cath lab. Patients who go through something like that don't often make it for one reason or another. But through collaboration with cardiac surgeons, vascular and perfusion specialists, and others, this patient pulled through. Every day I visited her in the CCU and she showed me signs that she was responding. The team that was caring for her doubted that she was responding until they saw that when I asked her to squeeze my hand she did. It was an incredible feeling to be involved with such a dramatic case and then to finally see her sitting up in a chair and ultimately, albeit a few months later, walk out the door of our hospital to a rehab facility.
What are some non-work-related things people might not know about you?
I’ve been married for 20 years and have two awesome kids, ages 17 and 19. I love the outdoors, especially being near the ocean and photographing things in nature. I also adore all things Disney. One surprising thing people may not know about me is that I coach my younger son's basketball team, which can sometimes be more challenging than any high-risk PCI I’m involved with!