Martin was employed by a central California hospital to operate the perfusion machine used during open-heart surgeries.

In the course of a year he officiated during 400 heart surgeries involving arterial bypass or valve replacements.

For the sake of anonymity, let’s call the cardiac surgeon Dr. Haskell.

Haskell’s philosophy included the concept that the shorter the time under anesthesia, the better for the patient.

And there were several other parameters also by which the success of the procedures he performed could be judged.

When Martin decided to move back east, he interviewed for employment as a perfusionist at several hospitals east of the Mississippi where also cardiac surgery was performed and where he might operate their heart-lung machines.

In each case he was rejected as if he were a personage from another planet or at least was untruthful in his responses to questions.

What length of time was usually required for a quadruple bypass surgery? Dr. Haskell usually needed 2 1⁄2 hours “skin to skin,” or from initial incision to final closure. The norm in the east was about seven hours.

What was the usual “pump time” or time when the patient’s heartbeat was stopped and the patient’s blood flow was dependent on the machine during quadruple bypass? Dr. Haskell usually needed 30 or 35 minutes. The norm in the east was two to three hours.

What did you use to prime the perfusion machine? We use an isotonic fluid purchased from a medical supply house.

In the east perfusion pumps were primed with five pints of blood.

Many of Dr. Haskell’s patients were members of a religious community which objected to receiving a blood transfusion. His shorter procedure times allowed the substitution.

What has been your mortality rate? During the last 200 cases we have not had a patient die.

In the east the usual mortality rate was 7 percent. Seven persons out of each 100 surgical procedures was considered an acceptable rate of loss to death.

Did you transfuse your patients with an albumin solution? No, with the shorter procedure times that was not necessary.

Albumin transfusion is done to prevent patient edema by keeping the fluid in the circulating blood. In the east albumin transfusion was routine.

Dr. Haskell did not need it because edema was not a problem when the procedure times were shorter.

The foregoing events were in the setting of 1975 medical practices.

When we lived and worked in California, we noticed that many of the personal dress fads or automotive innovations would originate in that far western state, then work their way eastward.

That may also be true for some advances in the practice of the medical sciences.
Martin’s experience in advanced practices unfitted him for working with physicians who did not use those practice modalities.

Bill Bradford has served as director of clinical laboratories in physician group practices and hospitals.
For a decade he was an educator in clinical laboratory sciences at Andrews University.