Moving Day

After thinking about it for a long time, I've gone and moved my blog over to antijenicdrift.com.

I hope you'll follow me over there as I keep writing about life, the universe, and everything.

Professionalism

A friend recently pointed me to this article about the professional responsibility and ethics that come into play when a healthcare professional is faced with treating a patient in a way that goes against their own beliefs. Since I'm a member of one of those professions, I thought I'd share my perspective.

When you commit yourself to a healthcare career, you don't have much control over what kinds of patients you will see. Yes, a doctor can choose to specialize in obstetrics or urology, and a nurse can choose to work at a retirement home because she doesn't like dealing with children. But you don't get to decide what kind of care your patients will get based on their politics, their religion, or their life choices. You can encourage a patient to quit smoking, but you can't give someone subpar care for their emphysema even if you feel, deep inside, that they brought it upon themselves.

Doctors take an oath to do no harm, and while I don't know if others in the healthcare professions do the same, I can say that the overwhelming majority of those I've known in those positions take immense pride in their work and treat all patients with great care and respect. Those who triage their patients by anything other than medical urgency quickly lose the respect of their peers. Or they lose their jobs.

That's why it bothers me when I read things like this, from Twitter right after the Boston Marathon suspect was taken to the hospital:

Now that the 2nd suspect is caught and in the hospital, what's preventing a Doctor/Nurse from injecting "go fuck yourself" serum?

Frankly, the very concept is offensive to me, and I think I speak for the vast majority of medical and allied health professionals. Of course the medical team isn't going to enjoy some vigilante justice and "accidentally" give him the wrong care to watch him die. And that's not just because so many people are watching, or because the police have instructed them to keep him alive. It's their job to keep him alive. Every single person who comes through those doors will be given 100% of their effort, because that's how a trauma emergency room works. It doesn't matter if you're a four-year-old who was hit by a car, or the drunk driver who hit him. You're a broken body, and they will do everything they can to put you back together.

I had a colleague who once told me that the lab he worked in years ago used to receive and test specimens from smaller medical facilities every day, because the smaller places didn't have labs of their own. When he found out that one of them was an abortion clinic, he refused to have anything to do with those specimens, saying that running the tests would go against his religious beliefs. He'd have had nothing at all to do with the actual abortion process, mind you. The specimens he would have been testing would have been for the women's blood counts and chemistries: tests no different from what you'd have done at your annual physical. Astonishingly, his coworkers and employer had no problem with his decision, and accommodated him. I couldn't help but wonder what would happen at our current employer if he was faced with a similar situation. We didn't deal with abortion clinics, but we did have several operating rooms and sometimes there were D&C's on the operating schedule - with no way to know whether they were being done after miscarriages or planned abortions, would he refuse to crossmatch blood for those patients if they hemorrhaged on the table? To be fair, I never saw him refuse any specimen while I worked with him, so maybe his attitudes had changed by then. I didn't probe further, because an ideological debate has a right time and a right place, and an evening shift in a busy laboratory is neither of those things.

The fact remains, though, that he did refuse care to patients based on a conflict between their decisions and his religious beliefs. It wasn't direct care, it wasn't emergency life-saving care, but it was still a massive breach of professionalism. And he got away with it. No disciplinary action, no reminder that a patient is a patient and a test is a test and you don't get to choose like that. 

I'm equally appalled by pharmacists who refuse to dispense the legal, FDA-approved Plan B contraceptive pill despite the patient's valid prescription. Like my former coworker, they get away with it. As long as someone else can fill the prescription, they can keep their conscience clean. And I think that's bullshit. Pure, unadulterated bullshit. Your obligation as a pharmacist is to dispense medications to patients. You don't get to decide not to give out Plan B because you're opposed to the idea, just like you can't refuse someone their diabetes pills because you think they should be exercising more and eating better, and you don't want to be an enabler. If you want to be a pharmacist and you want to avoid ever having to give out contraceptives, go work in hospice care or geriatrics.

It's simple. You have an obligation, when you work in health care, to do your absolute best for each and every patient you interact with. If you're not able and willing to do that, because your personal beliefs get in the way, then you need to find a new job.

Hasselback Potatoes

I dove into my recipe bookmarks this week, because I promised myself and the Internet that I would. 

I needed a side to go with chicken, and I found a picture of "Hasselback potatoes" on my Pinterest board, pinned from a fun cooking blog called Panning the Globe. They were potatoes (always good), they looked fancy, and I had all the ingredients! Well, except for the lemon, but I had lemon juice, and I could skip the zest. Also, I had the wrong kind of potatoes - Yukon Gold instead of the Russets the recipe asked for - but they were the right shape for the job. One of these days, I will make a recipe exactly as it's written. Probably. You would think that I'd have learned my lesson by now, but no.

You see, the recipe called for parsley. Fresh parsley, chopped up into the oil and lemon and garlic, to look pretty and, I assumed, be spectacularly delicious. I do not have any explanation for why I decided it was critical that I head to Wegmans to acquire fresh parsley for this recipe, while neglecting to purchase the other elements that I was missing to make the recipe like I was supposed to. Maybe I should have bought that stuff, because the potatoes didn't really turn out as I'd hoped.

The preparation was easy enough. Most websites that tell you how to do the accordion-slicing will suggest that you put a wooden spoon on either side of the potato to keep it steady and to prevent you from being able to cut all the way through. I tried that, but found it too wobbly for my liking. Instead, I wedged the peeled potatoes between two cutting boards to slice them, which worked really well and felt very safe. I whisked the components of the basting juice together in a measuring cup and brushed it onto the potatoes every ten minutes while they were cooking. 

Oh, they were pretty!

But they were very bland, tasting more like olive oil than anything else, and they stayed a lot firmer than I would have liked.

I can't blame the recipe, though, because, like a fool, I used my Yukon Golds instead of spending a little and buying a couple of Russets to work with. I know better. I've seen the episode of Good Eats where Alton Brown teaches us about waxy potatoes and starchy potatoes and which kinds are best suited to which types of cooking. Yukon golds are on the waxy side of the potato spectrum, which is (I assume) why they didn't absorb very much flavor from the lemon and garlic oil.

So I will have to try this again, using potatoes of appropriate starchiness, and see if it makes any difference. It's possible that some of the other Hasselback potato recipes out there, the ones involving cheese, would have worked better here, since Yukon Golds are supposed to work well in a gratin situation.

Oh well. Even if this recipe wasn't a big winner, at least I can say I've mastered the art of cutting a potato-accordion. I'm sure that counts for something.

Bookmarked For Later

I have a little bit of a bookmark problem.

I just went through my Firefox bookmarks trying to find an article I wanted to share with a friend, and noticed my "Recipes" bookmark folder, sitting there looking all small and closed and innocent.

"Oh, hi, Recipes folder," I said, "how've you been? Let me click you and see how big you've grown."

I have seventy recipes in there. At least a dozen of them are actually bookmarks for pages with titles like "Fifteen things to try with fresh lemons," or message board threads titled "Share your favorite soup recipes." Out of the list, I've tried exactly three recipes. That's pretty terrible.

Even terribler? I haven't been adding as many recipes to my browser bookmarks lately, because of a delightfully time-sucking website called Pinterest. I can save recipes from anywhere and get to them all on this one website! Even better, I can save pretty pictures of food that catch my eye, without even knowing what's in the recipe! The result of this witchcraft is that I have 74 pins on my "Food" board, only a few of which I've tried.

Add that up, folks. That's a minimum of 144 recipes. 

I need to get off my butt and start trying some of these. I saved them because I wanted to try them, right?

I'm making a commitment to myself here and saying I'm going to try at least one new recipe each week from my bookmarks, so I can weed out the ones that don't work and print out and save the ones that do.

I can't promise I'll come back and report on every single one (unless there's an overwhelming demand), but you'll certainly be hearing about the successes and the glorious disasters, because those are always fun to write (and read!) about.

Project: Bathroom Cabinet Hardware

This is what the previous owners left us in the bathroom.

I think these knobs used to be shiny brass, but that must have been a long time ago. Judging by the decor in the rest of the bathroom - tons of shiny gold-look brass - the bathroom was re-done in the 1990s and the knobs are probably 15-20 years old.

I looked into restoring them with scrubs and polishes, but they weren't solid brass. With brass-plating, once they're this far gone, there's not much to be done. I considered buying a metallic spray paint and making a mess in the backyard trying to get paint onto every edge of the knobs, but they'd need to be sanded down first to even out the tarnished surfaces, and it felt like more work than I was willing to put in for a bunch of knobs. Not to mention that my husband was not delighted with the idea of me screwing around with spray paint in the backyard, even though I reassured him the grass would only look shiny for a week or two while it grew out.

A short trip to Home Depot, fifteen minutes with a screwdriver, and I've got a bathroom that looks a tiny bit less neglected and dated.

The white plastic knobs are a little bigger than the old ones, but not awkwardly so. Most importantly, humidity won't bother them in the least, and they'll be easy to clean.

There's nothing I can do about the shiny gold trim on the shower doors, so I'll have to live with a little bit of bathroom bling. But I'm glad I was able to upgrade the cabinets to a smooth white-on-white look. Baby steps, right? Maybe new sink faucets next!

A Part of My Heritage

When a building is integral to the story of a place, sometimes government steps in and protects it from the forces of progress and change by calling it a heritage site. The home in Salzburg where Mozart was born. The Old North Church in Boston where furtive lanterns warned patriots that the British were coming. Tear down those buildings, and the towns don’t just suffer a loss of tourist money. Losing heritage sites is like losing history, diluting identity. 

You don't have to be a country, or even a city, to have a heritage sites. Everyone has places that played an important part in their lives, their histories. A childhood home where that one cabinet door never closed right. A corner store where allowances were spent on gummy worms. A park where someone knelt and offered a ring. Any place whose destruction you would mourn, because you could never share it with your children, is a personal heritage site for you. 

I'd like to share one of mine.

Place Ville Marie is an office building at the heart of downtown Montreal. It’s 47 stories of steel and sparkling glass, making an cross shape distinctive enough to earn it a place on postcards. A spotlight spins around on its summit after dark, sending out a bright white beam for miles.

At the heart of the cross, a dozen elevators whoosh up and down at an alarming speed, popping ears and making riders reach for something to hang on to. Downstairs, beneath the atrium where the sounds of high heels and conversations echo off the marble walls, is a shopping mall connecting it to Montreal's underground city.

Outside, between the main building and one of its small satellites, is a courtyard with trees and slick grey granite. Every warm sunny day, it’s filled with suits and their to-go lunches from the food court.

That courtyard is my heritage place.

I visited often enough during my suburban high school and CEGEP years, but once I found myself on the McGill University campus every day, I became a regular. Between classes, or before leaving for home, I'd come and sit on the granite ledges, alternating between reading a book and watching the water play on the green statue in the fountain. Sometimes I'd throw a penny into the fountain as I passed, although I can't say that fountain was any better at delivering on wishes than any other. When the weather got too cold for me to sit on the stone, I'd stand at the railing overlooking McGill College Avenue, a double-double warming my hands through my gloves, and take in the sparkling Christmas lights and the scarf-wrapped crowds.

The view is beautiful from that spot. McGill College Avenue, wide and tree-lined, stretches out from Place Ville Marie up to McGill's Roddick Gates and the campus beyond. Behind the university's old stone buildings, Mount Royal looms, its colors shifting over the seasons. I made sure to bring my husband here when he visited Montreal, to show him this little place that means so much to me.

I miss that courtyard dearly, and I always try to return when I'm in town over a weekend. I stay just long enough to throw a penny into the fountain, sip a coffee, and enjoy the sound of my city.

Where Do Babies Come From?

When a man and a woman love each other very much and want to have a baby, they share a special hug that puts a baby into the woman's belly.

We tell children variations on this story, adding levels of scientific complexity and biological grossness as they get old enough to need the details.

For 1 in 8 couples, though, this story isn't true.

Sometimes all the love in the world isn't enough to make a baby, no matter how enthusiastic the special hugging.

Sometimes, a man and a woman love each other very much and want to start a family. They throw away all the protection that they've been using since their parents taught them about the mechanics of sex, and they "try". It's fun and it's exciting and they hold their breaths every month as they check pregnancy tests to see if they made it.

And they wait.

Friends and family ask them when they're going to have kids. Soon, they say, and look at each other with knowing smiles.

They start to wonder why it's taking so long. They do some research. She buys tests to check her urine every day so she can find out when she's ovulating so they can have better timing. She buys a thermometer to take her temperature every morning before getting out of bed, to can keep track of her cycles. She drinks green tea and eats pineapples; someone on the internet said it helps. He takes vitamins and tries to eat healthier. She cuts out caffeine and pushes through the headaches. He avoids hot tubs on vacation. Every month, they wait two weeks after ovulation to see if they'll get a pink line on a pregnancy test.

And they wait.

Friends and family ask them when they're going to have kids. Soon, they say, and squeeze each other's hand for support under the table.

Someone tells her to just relax. Someone asks him if they've tried a different position.

They see doctors. They give medical histories. They have blood drawn. How are their hormone levels? Do they have any STDs? They send blood out to see if they're carriers for genetic diseases. He holds her hand as she lies back and tries not to faint while a tech squeezes thick gel into her uterus and fallopian tubes to see if the paths are clear.

And they wait: for the phone calls, the follow-up visits, the medical bills. They wait for answers.

Friends and family ask them when they're going to have kids. The silence is awkward.

Someone says they should try adopting, because their cousin got pregnant right after she got that girl from the Philippines.

Sometimes the problem is obvious, once the test results come back. Bad sperm, blocked tubes, hormone imbalances blocking ovulation. Sometimes it can be fixed with medication or surgery. But sometimes the doctors shrug and say there's nothing wrong that they can find, but that if pregnancy hasn't happened yet without intervention, it probably won't. They give the couple odds. They're bad. They cry.

There are options, of course, but they're expensive. Many insurance plans have little to no coverage for fertility drugs or procedures. Intrauterine insemination, usually the first step, can cost over $1000, and you're only buying a 15-20% chance at a viable pregnancy for your money. In-vitro fertilization has better odds (40-60%) but is much more invasive and expensive - approximately $10,000 per round. It's a whirlwind of tears and hormones, injections and blood draws, medical bills and invasive ultrasounds, and time taken off work for medical appointments. And it's waiting. Always, always waiting.

Babies come from love. Sometimes they come from science, too. Sometimes they come from donor eggs or sperm or from adoption. And sometimes, they never come.

Last week was National Infertility Awareness Week. Many people are reluctant to talk about infertility. Maybe they're ashamed of their issues, feeling like there's something wrong with them. Maybe they've heard one too many "helpful" comments and are afraid to tell anyone else about what they're living. Maybe it's too hard to talk about without crying.

Please take a moment to read this page from RESOLVE, the National Infertility Association. This is information that everyone needs to know in order to create a better support network for the infertile couples in their lives. Read it. Absorb it. Share it. 1 in 8 couples out there could really use your support.

That's why I'm walking in RESOLVE's 2013 Walk of Hope in Washington DC this June. Funds raised from the Walk support local RESOLVE programming, including support groups and educational events, public awareness initiatives, and advocacy efforts to ensure family building options are available to all. Because they should be.

If you'd like to contribute to the cause, my fundraising page is here. But just the act of you reading this post has helped the cause, too, so thank you.

Cookies

After a long, emotionally-draining day, I sat with my husband on the couch, glad for his company but too wrapped up in my own mind to notice what we were watching on TV.

"You know what, honey?" I asked him. I probably waited until a car commercial, because even when I'm distracted, I'm good like that.

"What?" He hit the mute button on the remote and turned to me.

I sat up a little straighter.

"I'm a tough goddamn cookie."

He smiled at me. 

"Yes. Yes you are."

"I'm... I'm one of those oatmeal cookies so hard you've gotta dip them in milk first so you don't break a tooth. Tough." I may or may not have flexed a bicep to demonstrate my toughitude.

He considered my statement for a moment.

"No, those are too brittle. You'd just fall to pieces. You're a Chewy Chips Ahoy. You bend but you don't break."

He kissed me, and I cried just a little. Then I wondered if maybe I was awesome enough to be the kind with the rainbow chips.

What else can I do with my medical laboratory degree?

To close out this year's edition of National Medical Laboratory Professionals Week, I want to step away from the hospital lab.

I left the hospital life a year and a half ago to move into an entirely different sort of laboratory work, but I still talk about the hospital every time I'm asked questions about the profession. I do it because it's the world I worked in the longest (so far) and so I know it very well, and because the majority of graduates from medical laboratory science programs will find employment in hospital labs. My information about working as a hospital med tech is relevant and well informed, but it's not the entire picture.

You can do a lot more than hospital work with a MLT or MLS degree. There are also positions available in walk-in medical clinics like LabCorp or Quest, and in some large medical practices. Some specialty medical practices, like endocrinology centers and fertility clinics, will also have their own small laboratory in-house to run some of the simpler tests. Often, in those places, a lab tech will end up doing more outside-the-lab work, like bringing patients into exam rooms, and taking blood pressure and other vital signs. Some of them are 24-hour places with shift work, and some are a 9-to-5 weekday job.

There are specialty laboratories that run all the weird complicated testing that other labs aren't equipped to do, like genetic testing. There are veterinary labs. Most manufacturers of food, cosmetics, and drugs will have laboratory staff to test their products for quality. There are labs that specialize in drug testing, for pre-employment screens or for athletes.

Depending on your interests, you can get yourself into a research laboratory at a university, or a place like NIH or the CDC. There are plenty of laboratories at the county, state, and federal level, also. Public health labs are the most obvious ones, but what about the FDA? EPA? Even the U.S. Geological Survey does a ton of microbiological research.

You can teach. You can travel and be a tech in other countries. You can get more technical and work for the instrumentation giants like Beckman Coulter or Siemens, either in tech support, sales, or research and development of new assays. If you like computers, you can get into programming and work with laboratory information systems.

And working for these companies doesn't necessarily mean you need to be sitting at a lab bench. Someone who's got a laboratory background can do very well in tech support, customer service and education, quality assurance, or regulatory compliance.

That's another area lab techs can move into - there are several regulatory bodies who oversee laboratories of different types. The American Association of Blood Banks, The Joint Commission, The College of American Pathologists - all of these organizations inspect laboratories for compliance and hand out accreditation, and need inspectors who understand laboratories.

Yes, when you graduate from a medical laboratory science program, you'll probably start out in a hospital lab, doing the shifts that the seasoned techs don't want. But you're not stuck there if you don't like it. It's been my experience that the school programs aren't very good at showing students all the other options that are out there, and how they can work towards them. Hopefully this post helps a few folks who are hating their night shift hematology job but don't know what else they can do with a medical laboratory degree.

Are There Any Questions? (Part 2)

How did you decide to enter this field?

I had a Bachelor's degree in Physiology and didn't get into graduate school on my first try, mostly because of a lack of practical research experience. I decided that the MedTech program would be a good way to earn some practical laboratory skills while I waited a year or two to apply again. I was surprised at how much I enjoyed the course material, though, and I ended up staying with the program and finding rewarding work in a hospital lab.

What kind of education and training did you have?

I already had a Bachelor's degree, and the MedTech program I graduated from was in a "CEGEP" in Montreal, which is similar to a US community college. While it was only a 3-year program, the Canadian Society for Medical Laboratory Scence (CSMLS) considers it equivalent to the 4-year college laboratory programs in other provinces. When I wanted to work in the US, my MedTech degree would have only been sufficient to let me sit for the MLT exam (Medical Laboratory Technician), but with my previous B.Sc. I could write the MLS exam and be a Medical Laboratory Scientist.

The final 6 months of that program were an unpaid internship shared between three area hospitals, where I worked 8-hour shifts in all the areas of the lab: hematology, biochemistry, blood bank, microbiology, and histotechnology. During that time, I got to work as though I were one of the hospital's regular employees, running patient specimens and reporting results. I was supervised and guided, of course, but after the first few days of training, I was mostly on my own and dealing with the workload as though I worked there for real.


What personal qualities are important for an individual considering this field?

Attention to detail is crucial, and an ability to detect when something doesn't seem right is a big plus. Sometimes a result might seem okay but in context it won't make sense - a good tech can sniff those out and deliver better care. For example, a really high glucose level might mean a diabetic patient in a crisis, but it could also mean that the specimen was drawn from the same vein a glucose IV is connected to.

Multitasking well is also helpful, because you're rarely just doing one thing. Most of the time, the laboratory staff is cross-trained to some extent, so that the tech running the urinalysis bench can go help the hematology tech if the workload is uneven. Especially on the off-shifts, where that type of "generalist" is much more common, you need to be willing and ready to be a team player. I know that gets thrown around a lot in the business world, but I think it's very true in the laboratory and I don't mean it in a dismissive corporate-speak way. The tests must get done, or patient care suffers. So if someone's getting backed up in their workload and you've got nothing to do, you get up, go over, and help. It's just what you do in the lab, because you care about those patients waiting for their results.

What do you wish you had known before entering this field?

The profession, while as vitally important to patient care as nursing, doesn't get very much respect. Few people know we even exist, let alone what we do, and our pay is much less than for nurses with equivalent education and experience. Unfortunately, this ignorance of our importance can sometimes exist within hospital management, and labs are often understaffed and overworked, with old equipment that can't be replaced due to budget cuts. We make do and we put up with it because we care about the patients upstairs in the OR or the ER or the maternity ward and want to do right by them.

That's why I care so much about Lab Week - I want to advocate for the profession so that we're more visible and our work is better understood. Without dedicated and caring laboratory staff, a hospital would fall apart.

What do you like best and find most rewarding about the career?

Knowing that every day, I did something to help a patient live longer or healthier by providing a doctor with a result, or preparing blood products for transfusion.

Now that I'm out of hospital work, I find I'm enjoying learning more about quality assurance as it applies to the laboratory. I'm doing more research and development work, and manufacturing FDA-licensed test reagents, and it's a lot slower-paced than when I was used to in the hospital. I like that I'm getting a chance to learn so many new things right now.

What do you like least and find most frustrating about the career?

Hospital politics and understaffing. It's hard to do a good and safe job when you're working on too many things at once.

How much influence do you have over decisions that affect you?

That depends on the specific lab and on the manager and supervisors. Good labs will ask for input before changing schedules, ordering new equipment, and adopting new procedures. In my experience, I have not had enough influence. That's part of why I took a break from hospital work (but being tired of evening shift was the main reason). I've never been very good at accepting "because that's how we've always done it" as an answer, and that sometimes gets me into trouble. I'm a problem-solver by nature, and I've always tried to improve processes by studying them first instead of just applying random fixes. While I think that hospital labs are starting to head in that direction, there's still a long way to go, and I often found myself frustrated when hospital management decided to "solve" a problem without really understanding it.

What additional training and qualifications are necessary for advancement?

There are levels of certification. MLT and MLS are the most common ones, but you can also take special courses for advanced certification in one specialty like chemistry or blood bank, and that is often a good path towards management. It's also possible to branch out from the hospital lab and work in other fields like quality assurance, manufacturing, instrumentation, and IT.

What specific advice would you give to someone entering this field?

Don't cut corners, ever. You have lives in your hands. Quality control is done for a reason. Procedures are in place for a reason. Don't ever let anyone else (nurses, doctors, management) bully you into cutting corners, either. Be prepared to work hard and probably not get a ton of kudos for it. I enjoyed the satisfaction of knowing the difference I was making, and I enjoyed the pressure and the feeling of being needed. It can be an incredibly draining career, but worth it if you want to be in healthcare and prefer working in a lab instead of directly with people. Oh, and if you're easily grossed out, or if you tend to faint at the sight of blood, this is obviously not a career for you.

Are There Any Questions?

Over the past few months, I've been preparing for Lab Week by collecting questions from my friends and readers about laboratory work. I've done my best to be honest, because the point isn't to trick people into joining the ranks of Medical Laboratory Scientists by painting the profession in a prettier light than it deserves. I love what I do, and my goal is to educate folks on what I mean by "what I do," and how I got there. If that inspires anyone to look into laboratory work as a career, that's an excellent bonus, and I encourage those folks to pipe up with any other questions they may have.


What sort of school is required for the job (in the US)?

That's a tough question, because "the job" can mean a few different things, and different schools handle Medical Laboratory programs differently. Most hospitals prefer to hire people who are certified by the American Society for Clinical Pathology (ASCP), so if you're considering a laboratory career, their website is a good place to start. This link will bring you to their certification section, where you can look into the various requirements to sit for the exams and earn a certification. There are several different certifications, and several ways to qualify for them, depending on your level of education and experience. In a nutshell, you qualify for certification as a medical laboratory technician (MLT) with an associate's degree, and a medical laboratory scientist (MLS) with a bachelor's degree. The difference between the two, in practical terms, varies a lot. Many employers will give an MLS a higher salary than an MLT, reflecting the extra years spent at school, but some places don't bother to differentiate between them. If you're looking to move up into management, keep in mind that most places will require the higher degree for supervisory or charge positions. You can also choose to certify in only one sub-specialty of laboratory science, like biochemistry or microbiology, but that will limit the areas you can work in, and all the schools I know of prepare you for the "everything" exams.

At school, you'll learn chemistry and biology and math and physiology, with a little bit of computer stuff and instrumentation thrown in. In my limited experience, a bachelor's level program will go deeper into the why and how of laboratory testing, but a graduate of a 2-year program is no less equipped to do the actual work. There are sit-and-take-notes classes, of course, but also many hours spent in the school's labs, learning techniques. Hospitals sometimes donate their older equipment to Medical Laboratory Science programs, so students get a chance to work with the instruments instead of just learning things theoretically. See if the school you're applying to has an internship program, or if you need to find work experience yourself. Internship programs are great because you get a feel for what the lab is really about, and employers get a free trial of you as an employee, so there's a chance you'll get a job offer out of it if you impress them.

Is it a good long-term job, or do most people get into it temporarily on the way to something else?

I think it's a great long-term job because of the job security. The laboratory workforce is aging, and there aren't enough new techs graduating to fill the positions left open when people retire. Hospitals are doing their best to cut back and make do with fewer techs, but the fact remains that someone's got to run the laboratory if the hospital is going to provide decent health care, so laboratory personnel aren't going to be downsized out of existence.

I'm happy that I made this career choice mostly because of the built-in flexibility. Because hospital laboratories are running 24 hours a day and never close, there are an incredible number of schedules to choose from. There are usually three shifts - days, evenings, nights - and some hospitals even have some swing shifts that fit somewhere in the middle. You can work full-time or part-time. You can work only weekends. You can be "PRN" (which means "as needed") and get called to fill in gaps in the schedule when people are sick or on vacation.

Not everyone shares my opinion about how good a career choice it is. Unfortunately, the pay for most Medical Laboratory Technicians and Medical Laboratory Scientists is far less than for comparable healthcare professions, like radiology techs, nurses, and pharmacy techs. Here's the most recent data from the US Bureau of Labor Statistics. Because of the lower wages, it's difficult to keep ambitious and talented young people in the field. Many younger techs I've worked with have used the laboratory as a part-time job while they go back to school to pursue advanced degrees in the hopes of moving into nursing or pharmacy. Let's just say that the med techs who stick with it long-term are definitely not in it for the money.

How much continuing education do you have to do? How well does your employer support it?

To maintain my MLS certification with ASCP, I need to complete 36 education credits every three years, spread across different areas of laboratory work. ASCP offers some online activities to help me earn credits, but unfortunately most of them aren't cheap. I try to look for free educational activities through vendors and other professional organizations. There are several ways to earn credit, including attending college classes, publishing a research paper, serving on committees, or attending lectures. The amount that an employer will chip in for educational activities varies a lot - education is often one of the first casualties of a shrinking budget. I've heard that some hospitals are very diligent about keeping their techs certified and helping track their education credits, but I've been more or less on my own so far.

If you're employed outside of the hospital world, certification maintenance is less important. Of course, keeping up on developments in your field of work is a good idea either way.

How much of your work deals with software?

Laboratory computer systems are interfaced with the hospital's information system so that tests can be ordered and reported electronically. Especially in hematology and chemistry, tests are mostly run on large analyzers which are hooked up to the computer system, so the techs only need to accept results on a screen before they send them on their way. You definitely need to be comfortable with learning how to work with new software if you're going to work in a modern lab, because the instruments all have their own operating systems, and most of your day will be spent ordering and reporting tests on computer screens. The more you can learn about how to make the instruments do what you want, and how to fix little issues that arise, the less stressful your work shifts will be. Of course, none of that helps you when the computers crash and you need to do it all on paper...

Do you have to wear different levels of protective clothing depending on the test?

I'm always wearing gloves and a lab coat when I'm handling specimens, because it's safest to assume that every specimen may be positive for something infectious. Where I am right now, all the blood I work with has tested negative for all the bad stuff, but it's important to remember that only means "the bad stuff we currently know about and test for." Blood wasn't tested for West Nile virus or Hepatitis C twenty years ago, and I have every reason to believe that some new bloodborne disease will become an issue in the next few decades and I'll find out that all this blood I thought was "clean" may have in fact been exposing me to some new pathogen. So I glove up, always. Why take a risk?

On top of the gloves and lab coat, I sometimes wear a face shield or work behind a splash guard if I'm doing something that might cause splashes. Cutting open units of plasma and pouring them into a pooling vessel, for example. That gets messy, and I don't need plasma in my eyes. I've also got big insulated gloves to wear when I handle specimens frozen in liquid nitrogen.

What's the neatest/most unusual thing you ever found (if you can talk about it)?

I think it's pretty incredible that in many cases, I was the first person to know that someone had influenza, or herpes, or leukemia. Until I called the doctor with the result, it was a suspicion. Afterwards, it was a diagnosis. That sort of thing kept me very aware of how important the work is.
 

Life as a Rural Med Tech

My friend and professional colleague, Scott, graduated with me from a medical laboratory technology program in Montreal several years ago. Our careers started very similarly, with both of us being offered positions in big Montreal hospitals. Last year, though, Scott made the decision to move to a tiny Quebec town so remote that there aren't any roads connecting it to the big cities and you've got to arrive by plane or ferry. 

Because he believes strongly in the advocacy aspect of Medical Laboratory Professionals Week, Scott was happy to allow a chat to become an interview for my blog. He will be translating part of this post for use in his hospital's newsletter to celebrate Lab Week in the far north.

Scott, you currently work in a very remote area of Quebec. Why did you decide to leave your job in a big Montreal hospital to work where you are now?

Changing from a larger institution to a more remote smaller institution was driven by the idea that I could be more involved globally in all the different branches of med lab. Larger institutions tend to train technologists in one particular area while a smaller lab involves more cross-training. Also, the quality of life in a small northern community was key in my decision to head north.

Downtown "Scottsville"

Besides the view and the shorter commute, what are the biggest differences you've noticed in how the lab is staffed and run at the two hospitals?

In the larger institution I found that quantity, tests per hour, turn around time were very important markers in the running of the lab. Patients are one of a number of patients. In a smaller lab; patient care and quality tends to be of the utmost importance. The results produced from a smaller lab are those of a neighbour, friend, or someone from one of the villages served.

I currently have three co workers. Two medical technologists and one technician. The shifts are 8am-4pm/10am-6pm/1pm-9pm Monday thru Friday with one 8am-4pm shift on Saturday and Sunday. All other hours are covered by an on-call service that is shared by the three medical technologists. Therefore, I do on-call every three weeks. I would say I'm called in on average 2-3 times per week. Emergencies most of the time are chest pains, heart attacks. Most big cases are transferred to larger tertiary centers. We are very dependent on charter airplanes: we have two planes on standby most of the time to move people around.

Scott's winter transportation

Would you go back to a big hospital, now that you've seen what a small rural hospital lab is like?

It would be difficult to return to a larger institution. I am happy overall with the job in the smaller hospital. I think it has more to do with quality of life than the actual job. There are crappy things to working here and crappy things there. Right now there is less crap here than there. :)

The Montreal General Hospital

Do you feel like a bigger hospital, because of its volume, is less able to be careful? Are the results coming out of the lab more likely to be inaccurate?

Quality is a difficult thing to judge. I don't think that results would be inaccurate but larger institutions with increased automation and being driven by quantity might have more difficulty picking up on problems that arise. Both institutions follow quality control and quality assurance guidelines; but to use an analogy, Ferrari produces very high quality cars but only produces a few per year while Ford produces millions of cars with very good quality but not to the standard of Ferrari.

"Scottsville": Home to the Ferrari of hospitals

Speaking of automation, is the rural hospital equipped with older analyzers, or are you working with newer versions of the instruments?

 

Each institution chooses instruments based on needs. The larger institution had a higher volume and therefore required newer and more performing machines. The smaller hospital had instruments for the volume that is done and therefore they do tend to be a little older but still produce very good results. As an example, I saw a new instrument being offered by a biomedical company that could produce over 4000 test results per hour. In the smaller lab, an instrument of that size would be useless. The smaller institution requires more reliable, proven instrumentation.

He's really, really far north

You're in a very very out-of-the-way spot and depend on ferries to bring you supplies. Have you ever had problems getting reagents or blood for transfusion due to weather problems? What happens when an instrument fails and needs repair?

On a daily basis, we are very dependent on the weather. If the weather is bad, sometimes we cannot receive orders or send out specialized tests to other hospitals. We tend to check the weather on an almost hourly basis due to the rapid changes that can occur weather wise. One of the most important choices in my opinion for the lab when purchasing instruments in to purchase reliability. But in cases when things do fail, a med tech must be able to tinker with instruments with the assistance of over the phone tech support. We do carry a few spare parts but most are sent next day if needed. If an instrument has a major failure, service contracts guarantee that service technicians will come out and have a look. The smaller lab does allow me to get more hand on with repairs.

A ferry bringing food so Scott won't have to eat his neighbors

What attracted you to the medical laboratory field?

I enjoy the scientific aspect of the job. I had gone to school in Chemistry and enjoy the idea of being more pratical than theoretical in the medical lab field.

Once you started work as a med tech, did the work resemble what you'd imagined it to be, or was it a shock to move from school to the work force?

The largest mental adjustment was probably dealing with stressful real life situations as compared to fictious cases. As medical technologist, we see the good and bad of most if not all health cases that pass through a hospital. The training I was provided in school provided both a classroom setting and a practical setting to help bridge the gap between theory and work life. Also, an internship in the last few months of school helped to limit the shock. Of course, in real life work, things are not always ideal and you're always learning about new things, new ways, and improving yourself everyday.

Med lab reality can get pretty gross

If you could go back to a med tech program where students are just starting the basic classes, what would you say to them?

I would honestly ask them if they are truly dedicated to patient care. Are they willing to work odd hours, weird shifts, weekends, holidays? The lab, as any other health profession, involves thinking about others more than oneself at times. You have to be willing to be flexible and available because in the end it is to help someone in need.

Lab Week Link Roundup

It's that time of year again, where the laboratory professionals emerge from their basement lairs and sniff the air hoping to detect the scent of muffins brought in by glassware vendors.

I write about my work often on this blog, and I especially enjoy highlighting my profession during National Medical Laboratory Professionals Week. It's a profession that's not well understood by most other healthcare employees, let alone the general public, and I feel that it's important for me to educate more people about who laboratory professionals are and what they do.

I do have some new posts planned for Lab Week (April 22-26, so I guess the weekend techs get no respect this year, what's up with THAT?), but because some folks might be coming here for the first time, I wanted to link back to some of my previous lab week posts so everyone has a chance to see them.

I've written about influenza testing, and how the doctor knows it's the flu and not just a bad cold, and what doctors are looking for when they hand you a cup to pee into.

Someone asked me about all those different tubes they fill with blood when you go for a blood test, and so I wrote a little about the different tube types and what they're used for. I took it a step further and explained what happens to the tubes once they get to a lab, getting into lab information systems and automation.

Because much of my lab career so far has been spent in the blood bank, I've also got a few posts out there about blood donation and what it's like to see regular patients receiving that blood. For those interested in more of the science behind blood types and transfusion, I covered a little of that too.

Two years ago, I made a (very amateur) slide show detailing how important laboratory professionals are to the health care team, and what exactly it is we do all day. And night. And weekend. And holiday.

Not all lab work is hospital work - I will try to talk more about that this year, but for now, you can have a look at what my job in a manufacturing lab is like. 

I hope you enjoy reading a little about laboratory work. I like writing about my profession, and I'm never sure how much detail people want to see in my posts about it, so I'm always excited to have Lab Week come around to give me an excuse to geek out about it a little. There will be a few more posts up this week, so please come back!

Blood Donation During a Crisis

A horrible thing happened in Boston this week. As is our human nature when faced with violent acts, people reacted with horror, sympathy, and an aura of nervous energy. Whenever there's a tragic event, whether it's a bomb, a plane crash, or a tornado, most of us feel like we should do something to help those affected. Even if we're far away, even if we're not directly connected to anyone who was hurt, there's this spark of humanity inside us that drives us to action.

It's crucial to note, though, that not all helpful actions are necessary, and not all good actions are immediately helpful.

Many people in my Twitter feed were urging people to go and donate blood. I am an occasional blood donor. I encourage people to be regular - for their own personal definition of "regular" - donors. But this week, when I saw the flood of "go give blood" tweets, I cautioned against rushing to the donor centers. 

Why? People were horribly injured and being rushed to hospitals for surgery. Didn't they need blood?

Yes, many of them likely did. But the hospitals were prepared. Every hospital has a plan in place to help them deal immediately with an "external disaster." They keep a good supply of blood on their shelves, and they have means to get more very quickly.

An organization like the American Red Cross* can move blood products efficiently from one area of the country to another. It happens every day, even in calm and peaceful times, but in an emergency, the wheels turn very quickly to get blood products to where they are needed as fast as possible.

There seems to be an almost-constant "blood shortage" going on, so it does seem confusing when Red Cross officials tell people not to come in right now and donate. What's important to understand is that the key to having enough blood available for a crisis is to have an adequate blood supply at all times. That's why the Red Cross encourages regular donations: the need is constant.

So why isn't more blood better? Why is the Red Cross of Eastern MA asking people to please wait and come in next week if they want to donate blood?

The thing about blood is that if you go to the donor center right now and roll up your sleeve, and have a unit taken from your veins, that blood will not be used immediately. It needs to be tested for HIV, Hepatitis B and C, West Nile Virus, and all sorts of other things. There's a two-day turnaround for blood products. Donating blood during a crisis isn't necessarily going to help the victims of that particular crisis. The Red Cross will do its best to accommodate all the generous donors inspired by the tragedy, but there's a risk involved with a huge rush of donors at one time. Blood is perishable. Units of blood get a 21-to-42-day expiration date. So what happens a month after the crisis, when everyone's just donated but all the blood is about to expire? Nobody wants to see blood wasted.

And that's why I urged people to wait and see whether there was a need before rushing to donate. Replenish the supply by donating a little later, so that there's always blood available for everyone who needs it.

What can you do to help when disaster strikes, then, if you shouldn't give blood?

1. Don't misunderstand me! Do donate blood. Please do. It saves lives and nobody would argue otherwise. But don't rush in after a disaster. Wait. See if the American Red Cross puts out a call for donors. If there is no immediate need, make an appointment a week in the future, or two weeks. Give often. Help keep the supply constant so hospitals can do their thing when they need to.
2. Follow @RedCross on Twitter or like them on Facebook. When something is happening, those accounts are very active and are an excellent source of news and support. There are accounts and pages for local Red Cross areas, as well. They will tell you how you can help.
3. Learn CPR and first aid. If you're ever in a position to give more direct help to someone injured in an accident or attack, you will be more confident and better equipped to act.

*I use the American Red Cross in my examples because I have a familiarity with their processes thanks to my work experience, and because they are a very important blood supplier for much of the United States. I don't claim to speak for them in any official matter.

Five kitchen tools I use all the time

Many months ago, I prodded my friend Tasha to write some blog posts about her kitchen tools - which ones she used all the time, and which ones she regretted ever taking home from the store. 

Given a few minutes to rummage through their kitchen cabinets, I think everyone can come up with lists like that. So I did. 

Digital meat thermometer

I don't know how I ever cooked meat before this thermometer came into my life. I switch it on, pull off the cover, and stab it into my teriyaki pork loin to see if it's done yet. My previous technique was to stab meat and see if anything pink came out, and then decide that either way, another few minutes would probably be smart. Let's just say I cooked with a lot of gravy in the old days.

Oneida plastic cutting boards

I use these pretty much daily. They're stained from years of use, but they're sturdy and easy to sanitize. They're grippy enough that they don't slide around the counter, which is a big plus when you're trying to chop onions on them with a huge sharp knife. Mom admired them when she came to visit, so she went home with a set of her own.

Pizza pan

Sometimes, I actually use this for pizza. Far more often, I use it for roasting veggies. It's the perfect size to hold a couple of chopped potatoes and an onion that I've tossed in olive oil and spices. I also use it to bake frozen pierogies and to broil garlic bread. I use it as a drip catcher when I'm making pies or a baked pasta. It has looked like hell for a very long time, despite my attempts to make it shiny again, and I'm okay with that. It does its job well and never complains.

Meat tenderizer/smasher

This thing has two "tenderizer" sides I've never used, but the flat pounding side has been a miracle tool for me when it comes to cooking chicken breasts. If I flatten them so they're uniform, I can cook them evenly and they don't dry out! I can't explain why it took me years to come to that revelation. These days, if I'm cooking chicken in the frying pan, I'm beating it to hell with this thing first. It's so much fun to smash things.

2 Qt KitchenAid saucepan

I picked this little guy up at Home Goods to replace a small saucepan that had sprung a leak at its handle. It's a nice heavy weight without being burdensome, and the rubbery handle doesn't get too hot to touch. I love this thing because it's exactly the right size. I always make rice in it. I cook veggies in it. I empty a jar of marinara into it and then dump in frozen meatballs to simmer them in the sauce. On the days I'm lazy and resort to those salty, convenient "noodle sides" packages, this is exactly the right size for them.

So, what about you, readers? What's in a regular enough rotation in your kitchen that you'd have to cancel dinner if it went missing?

 

Cake With Raspberry Filling and Lemon Cream Cheese Frosting

At first, I told my mother-in-law that I'd bring cookies for Easter dessert. I've got springtime cookie cutters and a pile of pastel-frosted flowers and bunnies and eggs would look nice and Eastery on the table. But while cookies were easy to make, cookies were not what I wanted to eat. I just couldn't shake my craving for a lemon and raspberry dessert. I went rogue.

I'm not really a food blogger, so don't critique my lousy photos.

The Cake

I made a white cake from a box to save myself a little time and trouble. I made 2 8-inch rounds so I'd get a nice 2-layer cake. I was not adventurous enough to go for 4 this time.

The Raspberry Filling

4-6oz fresh raspberries or frozen (thawed) raspberries

1/4c to 1/2c raspberry jam

Mash up the raspberries and jam until you get a nice lumpy raspberry goo. Spread it on top of one of the cake halves, leaving empty space at the edges for the inevitable oozing when you put the cakes together.

The Lemon Cream Cheese Frosting 

1  8-ounce package cream cheese
1  cup  confectioners' sugar
zest of 1 lemon, grated
Splash of lemon juice

I used this frosting recipe from Real Simple but ended up using less sugar than it calls for. I tasted it after one cup was added and decided I liked the balance of sweetness and tartness. If you like a sweeter frosting, then go ahead and add more powdered sugar. Also, be careful with the lemon juice. If you add too much, the frosting gets runny. Mine did, but it went on thick enough to coat the cake and firmed up just fine in the fridge.

The cake was a big success at Easter and it's already been decided that I have to make it again, preferably soon. I'm okay with that.

The Smashing Of The Bunny

It's a funny thing, to watch an octogenarian grin wickedly as she crushes a chocolate bunny's skull in her wrinkled hands.

The Smashing Of The Bunny is a decades-old Easter tradition in my family. Every year, a large hollow chocolate creature of some kind sits at the center of our Easter table, nestled in neon plastic grass, surrounded by Hershey kisses and Cadbury Creme Eggs.  A bunny, a hen, sometimes a squirrel, quietly waiting for us to finish our plates of deviled eggs and honeyed ham.

Waiting to meet its doom.

A different executioner is selected every year, and each family member has a different signature approach to the job. My brother grips the bunny's ears, and then delivers a sweet right hook to obliterate his belly. More than once, we had to retrieve bunny shards from the kitchen floor. My sister has a clean, top-down approach with the chocolate hens, bringing a swift fist of justice down onto her victim. I am the decapitator, squeezing the hollow neck until I feel a crack, and then lifting the chocolate head high in victory.

When I was first asked to bring dessert to Easter dinner with my in-laws, several years ago, I brought along a lovely chocolate bunny. The family was a little puzzled at first when I explained that after dinner, we would beat him into the chocolate chips from whence he came. Luckily for me, they're more than happy to include my family's strange ways with theirs, and we have had a Smashing Of The Bunny every year since. I'm incredibly grateful.

Because Easter isn't over till a chocolate bunny dies.