Society of Invasive Cardiovascular Professionals

The 10-Minute Interview with Tim Ugaldea, AAS

Cardiology Manager, Sacred Heart Medical Center, Spokane, Washington
Cardiology Manager, Sacred Heart Medical Center, Spokane, Washington
Why did you choose to work in the invasive cardiology field? While finishing a degree in anthropology, I worked as a janitor at Sacred Heart. One of the areas I cleaned was the cath/specials labs. I was intrigued by the high-tech instrumentation the techs were using. Things like Van Slykes, Tissot, Schlander, indicator-dye dilution devices and a slide rule (all of these needed just to get a cardiac output), E for M DR8's, Rotocore tables and cine film, were all to help diagnose heart disease so patients could be helped. They were also starting bypass for acute MI about that time which I found unbelievable. I looked into the Spokane Community College (SCC) program, switched degrees and have never looked back. Can you describe your role in the CV lab? I have managed the invasive and non-invasive cardiology sections for the past 23 years. Some days the job entails putting on the fireman’s hat with a siren on top, running around putting out fires, and other days it’s the sheriff's badge I don’t make the laws, partner, I just have to enforce them. Fortunately, most days are routine management, involving budgeting, contracting, meetings, evaluations and reading about the latest and greatest, and trying to figure out if we can afford to move in that direction. In the early days of management I worked in the labs. As the department and technology grew (and my eyes got worse) I felt I couldn't give 100% to both jobs, so in the interest of providing the patients with the best I quit assisting on procedures. I still try to spend time each day observing cases and keeping up with the technology. I don't feel I can do a good job managing if I don't have a complete understanding of what my customers, techs and nurses go through on a daily basis. What is the biggest challenge you see regarding your role in the CV lab? Like every other manager, the biggest issues we face are shrinking reimbursement and increased costs. Also, we have recently seen a number of private physician labs and community hospital programs open in our area that have cherry-picked a lot of the diagnostic, interventions, and easier open heart surgery cases from us. This leaves us in a position of still needing to provide tertiary care without the margins afforded us with diagnostic cases. Even without these programs opening I think most big programs will see a decline in their diagnostic procedures as new imaging modalities become better. We will all need to learn how to manage these changes while still providing the best care for our patients. What motivates you to continue working in the CV lab? The people I work with. Our average tech has been here for 15 years (in a range of 3-30 years) and I would match them against any cath lab team. All CVTs are graduates of the SCC program, so when we were hiring we were able to get the cream of the crop. The RNs all came from critical care units and the RTs from special procedure labs. Their commitment, knowledge, skill, teamwork and camaraderie are truly remarkable considering the changes we have undergone recently. I also enjoy the bizarre sense of humor they have, and that I've seen in most cath labs. I still find it amusing when my younger, newer employees refer to me as dude. I still am fascinated by the technology and get great satisfaction from knowing we have helped people survive events that only a few years ago, or so it seems, had a very poor prognosis. What is the most bizarre case you have ever been involved with? There have been many, but one that sticks out was when we were doing a renal angiogram on a patient. The x-ray machine in the back room started smoking. The doc continued till the firemen showed up at the door. In the early days of acute revascularization, we would study each patient prior to discharge. We certainly got good (nowadays the term is competency met) at defibrillation as almost every one of these patients went into VT/ VF when you shot that fresh vein graft. When work gets stressful and you experience low moments (as we all do), what do you do to help keep your morale high? I have found that a day in my drift boat fly-fishing on one of the Northwest's great rivers with one of my family cures almost anything that ails me. A glass of fine Washington red wine and a good cigar isn’t bad either. Are you involved with the SICP or other cardiovascular societies? I was a member of the national and Washington State Chapters of the National Society of Cardiopulmonary Technologists until it went …somewhere? I have been active in the Northwest Cardiovascular Management Association for the past 10 years. I recently joined the Society of Invasive Cardiovascular Professionals (SICP). Do you remember participating in your first invasive procedure? I had moved to management when coronary interventions started at my facility. We did bougie (I think Cook made the bougie set) some SFA and popliteal arteries in the mid-1970’s and had a cardiologist that would slip an .038 wire down an occluded coronary to see what would happen. Then there were the direct stick carotids, LV punctures and translumbar aortograms that I thought were very invasive. If you could send a message back to yourself at the beginning of your CV lab career, what advice would you give? I think the message would actually be for new folks entering the field. Working as part of the team in a cath lab should not be thought of as a vocation but an avocation. Always treat the patient with dignity and respect and as if they were your own family. In doing so, you will get more of a reward from your job than just a paycheck. Where do you hope to be in your career when it is time to retire? Since the light at the end of the tunnel is getting brighter each year, I would love to finish my career here at Sacred Heart. It has a great history, mission and value system and has been a home away from home for both my wife and I for a combined sixty-some years. We started a new pediatric interventional program two years ago that has been growing each year. I would like to see Sacred Heart recognized as a top pediatric lab and not just a top adult coronary and peripheral lab. Has anyone in particular been helpful to you in your growth as a cardiovascular professional? There have been a many physicians I’ve worked with over the years, from whom I have learned a great deal. Gerald Hensley MD, the first medical director of our cath lab and Carroll Simpson MD, a Mason Sones-trained cardiologist, did beautiful work (for those who never have seen or assisted in a Sones procedure, they were almost artistic) come to mind. There are many others too numerous to list. Sister Peter Claver, the Administrator of Sacred Heart for many years, was one of the most amazing persons I have ever known. She set an example that everyone should use to manage and live by. Finally, all of my staff. I have always believed that if you surround yourself with excellent people, they will only make you look good. Where do you think the invasive cardiology field is headed in the future? To quote one of my favorite bands what a long, strange trip it’s been. I think it will only get more exciting and that means better outcomes with less morbidity and mortality for our patients. Look at what has been accomplished in a relative few short years. I think better non-invasive imaging, better stents, percutaneous valves and gene therapy are but a few of the things that will be commonplace in the next 10 years.