1.2.3.You Are Live

Our center had done several live cases in the past. We took pride in being the first center in Saudi Arabia to transmit to EuroPCR and GulfPCR. Fortunately, I was not the primary operator then. My mentors & colleagues were. I assisted. It was exciting and a lot of energy was swirling in the air that usually started with the case selection (including a back-up), discussing strategy, setting up the cameras in the lab, and finally putting on the lead apron and getting on with it.

When I was finally offered an opportunity to be a live case operator for a SCAI program held in Turkey, it was a different feeling…a different energy in the air. It almost reminds me of when I had to do my first case as an attending…it felt very different from doing procedures as a fellow with an attending to fall back on…I had to remind myself that I’ve done this before many times. This time, I had to remind myself it is routine & business as usual..the only part that is unusual is the camera in front of me, the earpiece, and the microphone taped to my scrubs. I was particularly nervous for two reasons: unfamiliar lab (not my staff, set up, equipment) and I was the first women in our part of the world to perform a live case as the primary operator. I gave my mom a hug and told her I need her prayers..then I set off to Turkey. My parents were always my champions. They were proud of anything we did since we were children no matter how trivial. At that moment, I remembered my late father. He flew with me to my first meeting where I was a speaker. It was my first year as an attending. It was a small meeting in a small city and a small audience. He was still proud of me.  I wondered what his reaction would be to see me operate live on the big screen…and I thought daddy, this one is for you.

It was a bifurcation. I studied the angiograms and had a plan in mind. I remembered what my mentor said: “tune out the panel and do what you would normally do”. I walked into the new lab and familiarized myself with the staff, my co-operators, the equipment and asked for what I needed including access up front. I put the lead apron on and then stood while they hooked up all their audiovisual equipment. I could hear my heart pounding as they did that. My silly mind told me, they might hear the racing heartbeats through the microphone. Then it was 1.2.3. you are live. I was fortunate the moderator was well versed in his role, an experienced operator and capable moderator. He was the President of SCAI, Ehtisham Mahmoud. I focused on his questions and responded to him only. I tuned out all the other noise coming from the hall and panel. He did a phenomenal job of orchestrating the discussion. He knew when it was an appropriate time to channel the questions to me and when not to interrupt me. He engaged the panel and audience with a relevant discussion leaving me attend to the patient and procedure. That moment was when there was a flow limiting dissection at the distal stent edge and a second stent needed to be placed. The discussion resumed afterwards. The procedure was performed “as I usually do”: radial access, provisional strategy unless SB compromised or the FFR is significant.

I learned a lot that day. I learned I can overcome my fear. I can always challenge myself with something new. I also learned the value of intense training, being humble enough to accept wisdom and advice from mentors and the role of a strong moderator.

My tips to live operators:

Prepare.

The patient always comes first.

Connect with the moderator.

“Tune out the panel and do what you would normally do”.

My tip to moderators:

The operator is counting on you.