 Good afternoon. I'm Craig Vasalka and I want to thank you for the opportunity to speak today. I want to thank Debbie for inviting me. And she gave me the freedom to talk about whatever I wanted to. And as I thought about my career and I thought about my experience at Texas Heart, I really realize that as a profusionist we are members of a very, very unique profession. And I just want to kind of share some of my thoughts about our profession and some of my reflections of my career, which was 45 years. And just what a wonderful and amazing adventure it was. This was the class that I was a part of way back in 1975. It was before Color Film, obviously. And so here we are, a motley crew to say the least, but a wonderful group of people that graduated. And just the time that we had together is short. We were part of the six month program way back then. And I think part of that was that we really didn't know much. And we'll talk about this a little bit more, but as I've just seen the profession evolve. And I look at what the graduates know as I come out of school now. It's so amazing to what we learned. We had a little joke. Our main premise was to make blue blood red and don't compare. And I think that's still important. But I also believe that there's so much more that we do now need to know and do know that we didn't have a clue about back in 75. But as I said, I've had an amazing career, and I never would have guessed on that July 1 1975 when I walked into the operating room at Texas Heart, that what has happened over these past 40 something years would have ever been possible. And what about me as I said I was part of the 1975 class that started July 1 and graduated in December. I, at that time, I was a respiratory therapist and it worked at been top and St. Joseph's downtown in Houston. And after I graduated from Texas Heart, I stayed on and taught for a while. And then I did what I refer to as my gypsy years where I changed jobs a lot, moved around the country. In 1987 after being in and out of Texas Heart a couple of times ended up at the University of Washington, where I became the chief profusionist. After the first chief profusionist retired and became chief profusionist there. I was very, very active in AMSEC. And, and I served on the accreditation committee for profusion education. Just until last year for over 1617 years. I was a member of the Academy until they kicked me out. But that's a whole another story that we won't go into. My career at the university was just absolutely fabulous. I was a member of peer reviewed publications, and I was blessed to be able to speak at both national and international conferences around the world. And just wonderful experiences. And then I was blessed that I received the AMSEC award of excellence. I was the profusion of the year one year twice I received the research award for some of the work that we did at the university. And the probably the biggest honor that I've received is the John H. Gibbon award from AMSEC. You know, when I look at my name amongst those I truly realize that I'm not worthy of that reward. And as I said I never could imagine such a journey of back in 1975 when I when I started this this career and profusion. One of the most important things as I reflect on my career is the mentors that we are blessed with. And I thinking about this and reflecting. There's two that stand out of the many, many people that I had actually three to her fusionist and one a surgeon. And the first is one that we all know. That's Mr. Terry crane and Terry crane was the clinical coordinator. I don't know if he's still called there was a time when it was called the pod rat. And Terry, Terry was that that person that ran the operating room and when I was at Texas heart as a student we had eight rooms at the old St. Luke's hospital. And Terry was there every morning running around. And they say mostly running around a lot of times he was back in the days he was smoking a cigarette and so he was in the lounge. But Terry was always there for you can always because always there to help always answer questions to kind of look at you and give you that little look that he has, and you knew something wasn't quite right. He was one of those instructors that made you think. And, and so I, I really appreciated him and I learned a lot from him. There was also the day that we, we kind of hated him because he called us to the classroom and told us that we were the worst class ever. I don't know if we still hold that that reputation in his esteem, but he told us that and we all went, thank you sir may we have another and went on from there. But like I said Terry, Terry had a good balance and I really appreciate it all that he taught me and instilled in me about profusion and checking and rechecking and then checking again. The other, the other profusionist mentor that was probably one of the most important people in my professional life was Mr Dan Wiltfang. And Dan is one of the pioneers of profusion. He was at that first meeting in Chicago back in the 60s when Amsec was formed. And then Dan was my chief profusionist, my boss at the University of Iowa where I spent a couple of years in the in the mid 70s. And Dan was one of those guys that taught me how to be a boss. And what to get upset about what not to get upset about was always there to answer questions and just had so much experience. That was just amazing. And never, never seemed to lose as cool in the operating room could get out of any rough situation. And the main thing was that that he may get upset and yell at you personally for some of your dumb mistakes and I made many back then. But Dan always supported us in front of the surgeons and the rest of the hospital. And so he was a great mentor as a boss. And thirdly is Dr. Varie. And Dr. Varie was my chief of cardiac thoracic surgery at the University of Washington. He wasn't the person who hired me and that was a little story. I got hired in February I took the job in February 1987 and the surgeon that hired me kind of left abruptly in September of 1987. And then in 1989, rather 88, Dr. Varie came. And I remember when he came and I sat there thinking okay. I got a new boss now what do I do and so I walked in and said, introduced myself and said I don't know if you want to bring your own profusionist. Please let me know. And he looked at me and said, I don't know I've heard good things about you and I don't think Dan wants to come. He's the guy he worked with in San Francisco. And so we'll figure out we'll work it out. And he became such a great mentor. He taught me how to do research got me in the lab and got me very involved and allowed me to write his coattails and a lot of the work that we did. And so I, I just want to encourage people that to be thankful of their mentors but also so to seek them out and to seek the knowledge that they can share with you and help you in your career. And then ultimately, the people that need to be thanked the most. And as I look back, are my family, especially my wife, Victoria. And my daughter, Sherry, who put up with all the crazy hours that we work as profusionist. They put up with the things that I missed when I was called out in the middle of the evening birthdays, Christmases, all the hectic schedules. And then as I got more and more involved with, with Amsect and research all my travels, and just our families are so important to us. And we always need to be thankful and mindful of their presence and the sacrifices that they make so that we can do our job and what we want to do as profusionist. My two grandsons are just kind of what keep my sanity. There, there's different as night and day. One's very intellectual and one's very musician and the other one is the jock of the year, and Mr basketball right now. They are, they are just they keep, they keep me saying, keep me young and are just a joy in my life. And so, again, I just want to encourage profusionist as we as we do this job. We get called out to take care of total strangers and we leave our loved ones at all times to always be mindful and thankful of your families. Some of our colleagues will drive us crazy. And then there's others that that are just, you know, really our support base in rocks. And there's three that I really, really want to thank in all my years. I mean, I have so many, but there's three that I really want to thank. And one is this guy Dave Anderson. This is Dave after many very long night of transplants. But Dave is a rock. Dave was at the university when I got there and is still there today. And he loves what he does. And, and Dave always told me, I tried to get him to help me in the lab and stuff and he would come down and do the work I go do you want to give this paper do you want to go talk and he goes no. And Dave says, I want to make it to where you can do it and make the university known. And so Dave was the foundation in many ways of what I got to do. And I'll always be grateful for him. And then there's two other colleagues from the university. And one is this lady right here Debbie Bly and Debbie was a Texas heart student. Someone who I have taught and she was at the University of Washington, when Gary, my predecessor retired, and she suggested I come up for this job. And, and then got it. And so I'll always be be grateful to her. And for what, what that allowed me to do. And the other is Gina Rose and Gina is also a Texas heart graduate. And Gina worked in our lab as an undergraduate as a student helper, and then got interested in profusion. And Gina is one of those people that just always renewed my, my hope and my dedication to profusion she loves, she loves being a profusionist. She worked with me at the university after she graduated for a number of years and now is at a smaller hospital at private practice. And she made that decision because of her family that she could have a little more time with them, and not the hectic schedule that we were doing. But both of these women are just phenomenal women, mothers colleagues, and I will always be grateful to them. And they've also all three of these people were the ones that would tell me when I was messing up. Dave, Dave once told me I think I'd been at the university maybe five years and Dave says, So you know, boss, everything you did when you got here was right, but you sure did it wrong. And, and he's right. I did and I think that's one of the things that we get trained as profusionist to be clinicians. And then many of us end up in these leadership managerial roles without a clue of what it means to be a manager what it means to be a boss. And, and so we need people that are good sounding boards that will keep us honest that will make us aware of our mistakes so that we can improve and continue to grow both professionally and grow our team. And I think one of the biggest blessings I have is is the number of friends that I have made in throughout my career around the world in profusion friends and colleagues have just been so great. So just a few. These are some, some people from the European society. This is Paul Coppola from AMSEC. Brian one of one of my colleagues at the university, Mike one of the nurses. This is part of our team. This is a meeting we had at the Washington State profusion society, Renee, who's on the treasure of AMSEC now and worked at AMSEC with the Americans. Tamer from from Turkey, and again, more of our team at the university, long come from China, who's become a very, very dear friend and colleague over the years. We've exchanged time at each other's hospitals and meetings. And just the opportunities that were afforded to me as I said, I would have never imagined back in 1975 when I when I started this job. And, and these aren't unique to me. And I think part of the, the challenge that I pass out to you as you're in this career is that you take advantage of all the opportunities you have. People I've heard over the years say, we don't, we don't work at a university so how can we write a paper we don't have any research. We can all, we can all write case reports. And so I just encourage you to look at what you do, and then take the time and the effort and get involved and share your experiences because your experiences can help others. I mean, back on my career and looking forward to what's going to happen or my crystal ball if you will, of what will happen is I think something that again I thank Debbie for giving me this opportunity and the freedom and talk about whatever I want and I hope I'm not But if we look at the history before given this, this whole concept of how could we maintain life has been something that's always been looked at. I don't remember the gentleman's name, but one of my favorite guys I learned about was a Frenchman who would be at the guillotine's and when they cut the heads off, but then inject blood up the carotid artery and the guys the eyes would still believe. And this was kind of like his idea that we could maintain life if we could come up with some type of way to keep blood going to the brain. We have Harvey who's known as the father of circulation and then Malguipi who described the capillary system which is so important to the circulation and what we know and enables us to do our job. And then McLean who discovered accidentally actually who discovered heparin that has made extracorporeal circulation all possible. And we have Gibbon who gets gets the credit and he began his work looking at extracorporeal circulation back in 1930, and then in 1953 23 years. He first does the first successful use of cardiopulmonary bypass. After taking care of this patient repairing her ASD. And then he goes on to do five, five operations and only one that was successful. And he got so depressed he never did another operation. And so while giving gets the credit for doing the first one. Really, it's the people like little high and the wall that carry on this and end up really making cardiopulmonary bypass would it successful and gave people the opportunity to keep working and go forward with this and then the evolution of bypass began. And so as I look at my 46 years in perfusion, as I look at all the the adventures that I've had. You know, as I said I started with as a student at Texas heart and 77 suddenly ptcs came and you know, and every time something like that and intervention has come in. The questions always come up as are we going to have jobs anymore. In 1978, Texas Heart did 4000 operations that year. And then in 1980 we did 5000 open heart procedures it was, it was a phenomenal year. And this was, I don't know if we had the 10 rooms then or not if we were still in the eight, but we did 5000 operations that year. And it was just amazing. And so we sent out a Christmas card every open heart program in the country. And Dr Cooley couldn't do it himself. The profusionist sent it out to all the other profusionist in the country, knowing that the surgeons would hear about it. In 86, suddenly we're faced with stints and again, the whole thing comes up is this the end of cardiopulmonary bypass. In 87 I go to the University of Washington where we're doing 1000 cases a year. And it was like such a slow pace to me, I actually was bored and thought, wow. I'm not sure how long this is going to last. And then in 90 in 89. Another balloon stint comes out. And then we get to the drug eluding stints. And then we start getting into tavers and oh three, oh three we started playing with tavers. And then finally in 11 tavers get approved. And so then in 14 we suddenly start looking at aortic stints. And, you know, are we going again, the questions come up, you know when when are, when are we going to be out of jobs. And we went through the whole off pump cabbage thing. And I remember going to meetings and people just saying what are we going to do we're going to be out of jobs. And I kept saying no we're not, no we're not. In 2019 and 2020 rather, we get hit with COVID and egg mode just starts booming. And so there's just been so much. And then, and then we get to 2022. And the question I think that we need to start asking ourselves is what will be our role how do we fit in. And, and what is the future for profusion. I mean, a letter once where a student was saying they were thinking about this career but wonder if there will be jobs. And I look back and I went and dug up and found that letter. It was actually written to me in 2003. And I thought, wow, how many times have we gone through this during my career. But as I said, it's been such a blessing and such a wonderful career. And the greatest gift of all that we have all that we get to do is our patients. I think of the way that we contribute and be by being part of this team that we allow people to basically get a new lease on life. And while I haven't done children. Since I went to the University of Washington because we have one children's hospital in Seattle does all the kids. I don't do kids anymore. Excuse me. I don't do kids anymore. And, but I remember always thinking when I was at Texas Heart doing a lot of kids, how wonderful it was to see these little blue babies come and then leave the operating room pink. And to see as I, because the way I walked out of the hospital back in those days is I would leave through Texas children and to see the smiles on parents faces. And you could always tell the parents whose children will have it hadn't gone to surgery yet. And you could see the nervousness and the worry on their face, and then the smiles on the others. And so it was such a great, great gift. But I think one of the most wonderful things that we get in the uniqueness is there's no other job or profession where someone intentionally and totally puts their lives in the hands of someone they most likely have never met. Very few of us go and see patients pre op. Very few of us go see patients at all. We see them in the operating room. But yet these patients, and many of it unbeknownst to them, I don't think they totally understand what we do. They totally entrust their lives to us, because what we do when they're on the heartland machine when they are connected to us in our own cardiopulmonary bypass is totally allow us to control their lives for those few hours that they're on the bypass machine. To help all of you always take that seriously. It is such a gift and such an honor to be able to be a part of someone's life in that, in that way. I think we get to see patients at their most vulnerable times. We get to help people change, check their lives change. A lot of cardiac cripples come in and then leave and go through rehab and able to go back to their jobs and return to somewhat of a normal life. We get to contribute to the opportunity that they'll get to spend more time with their families and friends. This is a true blessing that I don't think we always realize what we're doing in our job. I know there's many days that it became just a job. Many days that it was another operation. And I got to a point in my career where I stopped every morning, and I just thought about what we were about to do. And really, again, reawakened me, rewoke me and allowed me to kind of renew my dedication to what we were doing clinically and in the operating room and what a blessing it was to be part of that team. I've had an amazing career, and I just recently retired. And so one of the questions I have as an old man who's had a wonderful time is what will profusionist, what will the profusionist in 1953 and 2053 100 years after Gibbons did that first case. What will we be doing. And I really wonder about that and wonder what the future holds. I know I look back and see the evolution of oxygenators from using the old traveling all bag which was two sheets of plastic, and we have pumped air in it. And, and I just look at how crude it was when we did that just pump bubbles in the blood. And then have it go to the stock this stainless steel defoaming sponge it looked like a brillo pad to try to get rid of all the bubbles and then go on. And I look back at how much we've improved how much we've improved over the years. I remember the first time I heard the word compliment in the operating room, and I thought that was supposed to mean somebody said you did a good job and they gave you a compliment. We didn't know what that was and as I said, in 1975 when we were at six months program, it was because we didn't have a lot to learn. And so I think what would the graduates coming out today what they have in the past several years have come to learn is so much more than we ever knew, or had the ability to learn, because that knowledge just wasn't available. I mean we used to give blood like it was nothing. And now we know all the dangers of transfusion. And so what, what will it look like in what 20 years, 30 years as we hit the 100th anniversary, what will we be doing. And nobody knows the answer that I don't have a crystal ball. But my, my words to you my challenge to you is don't rest, don't rest. I think in many ways, and it's a very good thing. Cardio pulmonary bypass has become so routine open heart surgeries that become very, very routine. In most cases, that we don't, we don't always appreciate the history and the evolution of what has happened in cardiac surgery. And once was in the lab with a with a fairly new graduate, and in the lab I would build my own tubing and, and just adapt circuits, left and right for what we were doing that day. And they showed me and looked at me says, How do you know how to do all this. And I remember thinking to myself and I asked him I said the question is why don't you know how to do this. Why can't you figure out how this circuit's going to be and what you need to make it work. And that is the challenge is that we never forget all the history all the roots, all that has evolved. And then what can we do, there's still so much more to be done to make bypass even more benign than it is today. And one of the questions that I really, really worry about is, is, do we look at this as a job, or do we look at it as a profession. Things that started driving me crazy these last couple of years as we would hire people at the university. And they would be talking about this work life balance. And while I understand that I was probably a little crazy and as I said I missed a lot of stuff with my family. But I think to become a true profusionist. And as a person versus a pump tech, you have to be willing to invest yourself into this profession, and not see it strictly as a job, but as a true profession, a true calling in your life to take care of patients to contribute to the science and the art of medicine, and continue to make improvements as we move forward in the timeline of cardiac surgery. And so the question is, can we do it, or perhaps, since I've retired, the question is, can you do it? Can you do it? And I think based on history as I look at Gibbon, as I look at other mentors, as I look at these two men that just popped up, Dr. Frazier and Dr. Cooley. I think the answer is yes. I look at Dr. Frazier who I've known since he was a general surgery resident. Dr. Frazier was a fellow at Texas Heart when I was a student, and just look at what the contribution see has made. Just in the work with VADS is so amazing and astonishing. How many people have VADS today and how many people are alive because of the work that he's done. And then Dr. Cooley, I can't begin to say enough. I mean, there's been so much written. I just recently read the book Cooley that was written back in the late 60s, early 70s, and just looking at his career and the way that he mentored so many great surgeons. The way that he supported the School of Refusion Technology and the contributions that he made are absolutely breathtaking and unimaginable that one man could do so much. And so I feel it was such a great privilege and honor to work with these two men at Texas Heart and to known them as long as I have. Jeff Riley, who recently passed away, made so many contributions, so many steps to our profession. And as someone whose work we should always be thankful for, and I give so many thanks for being able to call him my friend. And so can we do it? Yes, we can. I truly think, and I always had the Bob the Builder attitude, I would look for ways that profusions get more involved. I wanted to be irreplaceable in the hospital. And while I would drive my colleagues crazy at times by saying, stretching us a little bit more saying we can do this, we can do that. We need to be involved. We are the professionals, we are the experts in extracorporeal circulation. We need to be involved with blooms. We need to be involved with VADs. We need to be involved with ECMO. It's painful and time consuming as it can be. We need to do this. And so the future, the future is always beginning right now. The future is beginning to now. The future will begin tomorrow. It began yesterday. It will begin again and again and again. And only you and only you, as Dr. Seuss would say, can control your future. The decision is, what are you willing to invest? How are you willing to contribute to the team, to your job, to the future of cardiopulmonary bypass, the future of our profession? And so I ask you and I challenge you again to do that. And so I just want to thank you for your time. I want to thank you for listening. I want to thank you for being part of a profession that I have truly loved. I wish you all the best. And to the young profusionist out there, I say, open your eyes, open your hearts, and open your minds to all the possibilities. Don't be comfortable with the status quo. Always look for ways to improve. Look for something that you can make a change with that will make things safer, make things better for the patient, for the team, for what you're doing. And mostly I say God bless you as you continue in this work. And I hope that your career is as satisfying and as fulfilling as it has been to me. Thank you very much.