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.

It’s Kind of Like They’re the Mary-Kate & Ashley Olsen of Christmas Ornaments

Note: Because I skipped a day of the Ornament Advent Calendar, and because I received a beautiful new ornament as a Christmas gift this week, I am doubling up on today's posts with the help of my good friend Natasha. She wanted to write a piece about the ornament she sent me, to explain the motives behind her choice. Here is her guest post. I'm going to call it post #21. My post about the ornament will be up later today, and will be #22.

Ornaments! Left: Natasha Right: Jen

You know what I mean. Fraternal twins that look so much alike you wonder if they’re identical. But if you look hard enough, you can see the differences.

Admittedly, our ornaments are more obviously different than some of those twins. Jen’s ornament is dark blue on dark blue. My ornament is dark blue on light blue. Totally different.

The pattern on the ornaments is the same though, and that’s most of what matters here. For most people, this pattern is just some strange streaks down the left side. However, once I laid eyes on it, I knew Jen had to have it for the pattern. And so did I.

See, that pattern is actually what makes these ornaments perfect. They’re little watercolors in petri dishes, so they’re already “sciencey” looking. But that pattern is a painting of how microbiologists isolate bacterial colonies. To isolate a single bacterial strain (thus, genetically identical), microbiologists or lab techs (HI JEN!) or students or whomever starts by streaking a big ol’ mess of bacteria from an old plate to a new one. Then, they sterilize their streaking implement (usually a metal tool called a loop) and draw a line through the heavy streak, and streak again a bit more wide-spread. Once you repeat that twice more, the last streak should result in not lines of colonies grown together, but isolated colonies that each resulted from a single bacterium. (Wikipedia has a great image. And about.com has a very clear write-up, if you want more details.)

I had to get this for Jen because she’s undoubtedly done this a million times. (I’ve probably only done this a half million or so.) Because she’s a total science geek, just like me. Because it’s beautiful in it’s own right, but there’s like a little secret hidden in the art if you’ve been there.

Because we have a similar background with a lot of shared experiences, and I realized this could give us a tangible link to those shared experiences that we mutually geek out about regularly.

I hope she takes it on that cruise she’s always talking about and shows it off.

Natasha and I are long-time Internet buddies. We try to get together in reality sometimes, but we live far apart. Still, we talk a ton online, and I think we get along so well because we both like to geek out over stuff in our own ways. She runs a blog of her own, MetaCookbook, where she discusses food, science, and beer, and treats her readers to some fascinating blather along the way. I encourage you to check out her stuff. She's not a recipe blogger, and she's not a rabid granola foodie. She's just someone who loves food, from growing it to eating it to the communities it can build. She's funny and smart and real and I get mad at her when she leaves the blog un-updated for more than a week. That should be enough information to get you over there for a look! 

- Jen

Thankful

Many of my friends made November into an exercise in gratitude, taking time each day to be thankful for an aspect of their lives and to share those thoughts on social media sites. I didn't climb onto that bandwagon, even though I enjoy challenges and I think that this one in particular is wonderful and meaningful, because I was in a dark and bitter place as November rolled in. I didn't feel like I could be genuine in my gratitude.

I feel like it's been a long, rough year, and I will be genuinely glad to shut the door behind it. I suspect that I will feel tears of relief on my cheeks when the New Year is rung in. I sat to write this post today, and at first, all I could think to say was that I'm grateful the year wasn't any worse than it was, but that isn't really in the Thanksgiving spirit, is it?

I am thankful, above all, for my husband. He has been a steady and level presence, as he always is, and he has helped to hold me up. More than ever, this year, I am grateful that we cope with life's rough patches in different ways and that our personalities complement each other. If I'd married someone who was more like me, this would have been an even more difficult year. I am so, so grateful for his love and patience.

I'm thankful for my family back home in Montreal (and Vancouver!). I don't see them as often as I would like, but phones and the Internet are wonderful things (for which I am also grateful) and help us to stay together. I'm glad that my parents are both happy to put their busy lives aside to answer when I call, and are so eager to stay involved in my life.

I'm thankful for all of my in-laws, for being the sort of people who call me family and mean it. I don't think I could have stayed here without knowing I will always have the support of my American family.

I'm thankful for my friends, both online and off. They trust me to listen to their troubles and offer support, and they are always ready to return the favor. I'm especially grateful that they are the type of people who are happy to pick up the friendship where we last left it, if time and work and life's demands keep us apart for a while.

I'm thankful for my home and all the projects we've accomplished in it.

I'm thankful that I now have a job that pays my bills without jeopardizing my health, and coworkers who enjoy being silly whenever they can get away with it.

I'm thankful for the tools I've learned to use against the heavy blanket of depression, and for the progress I've made so far.

I'm thankful that many of my complaints are "First-World Problems". I live in a peaceful country (angry election rhetoric notwithstanding), where I can do, learn, and say what I please, and I always have clean water and access to good medical care. Compared to much of the rest of the world, I've got it pretty good, so I guess a little gratitude is called for. I'll try not to forget that as I welcome a new year.

Writing Assignment #3

There was no writing class last week, because of Hurricane Sandy, so I had two weeks to work on my "character" assignment. I started it and restarted it and walked away from it and got generally very grumpy at it over those two weeks. This is an important story for me. This is the first time I met Michelle, who would go on to be a very dear friend for - holy crap, almost two decades now. I can't swear that this is exactly how it happened. In fact, I'm probably wrong about much of it. But my hope is that the essence of that evening comes through anyway. I feel like I had to wrestle this one onto the page!

Michelle gave me her blessing to post this.

Meeting Michelle

The beat faded. Movement in the room slowed. Costumed dancers glanced around for a cue, shuffling their feet, ready for the next song. The first notes of a Bon Jovi power ballad began over the last of the pumping bass, and the crowd diffused. Boys gathered by the long tables folded against the wall, and girls huddled near the foggy windows. The school's few established couples moved to the center of the cafeteria to rock back and forth, hands an arm's length away on each others hips or shoulders. 

I sighed. The glass of the window was cold on my back.

“God, will they stop playing these slows?” Melissa huffed. “Nobody dances to these stupid things and they keep playing them.” She watched the boys' side as she said it, her eyes dancing around as she tried to avoid staring directly at Mike. He was oblivious to her gaze, as usual.

I rolled my eyes at her.

“Whatever, Mel, if you're not going to ask him, it's your own stupid fault you're stuck over here.”

She glared at me.

“I'm not stuck anywhere. I'm going to buy a drink.”

Obscured by the dark haze of the dance floor, we played our assumed characters with a measure of confidence, but under the fluorescent lights of the canteen area, our careful makeup and our homemade costumes seemed amateurish. I adjusted my pink poodle skirt, moving the fluffy white poodle appliqué back to the right side. Mel twisted her hairsprayed curls and straightened the headband holding up her devil horns.

The price list was fixed to the canteen kiosk with wide blue strips of painter’s tape. Brightly-markered bubble letters announced the going rates for drinks, chips, and chocolate bars.

“I'll get us some Cokes,” I said, reaching into my purse for some money. “You can owe me.”

The girl running the canteen wasn’t wearing a costume. She stood expectantly in the little kiosk, waiting for my order. I recognized her as the new girl, who had appeared in the halls at the start of the school year, but couldn’t remember her name. She didn’t share any classes with me, so we’d never spoken.

“Two Cokes, please,” I asked, putting three loonies on the counter.

Mel poked me in the ribs. I glared at her and sighed loudly.

“Aaaand a bag of Doritos.” I added a another dollar.

The canteen girl had our Cokes out of the cooler and the chips on the counter in a flash, and handed me back my change – two quarters.

“Nice costume,” she offered. “Where did you get that skirt?”

“Thanks,” I replied, “my Mom threw it together.”

In fact, Mom had put so much effort into my costume that she’d even used a gold-tone chain from her own jewelry box as the poodle’s sparkling leash.

Mel popped open her Coke and took a sip, and we all stood there for a second, unsure who was supposed to say what next. At that moment, the volume of the music in the next room jumped up a little, and canteen girl turned her head towards it excitedly.

“Aw man, it’s the Twist! Somebody’s gotta come and dance with me!” She looked at Mel and me, hopeful.

Mel shrugged and popped a chip into her mouth, crunching. I looked at canteen girl and raised my eyebrows, gesturing to my white sweater, wide, tulle-puffed skirt, and crisp white socks and sneakers.

“Ummm…” I offered, “Duh!”

We were probably the only ones on the dance floor – I don’t recall. All I remember is the way my sides ached from my vigorous Twisting, and how my arm almost jerked out of its socket when canteen girl and I tried to get fancy with a twirl. We went up and down and round and round until the DJ moved on to something else, leaving us to pant our way back to the canteen.

“That was so much fun!” Canteen girl smiled at me. She held out her hand. “I’m Michelle.”

 

Playing with glass

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My friend Leila and the fight of her life

"Jenny, I had a seizure."

Her email says to call her as soon as possible, so I do, not even waiting to get home, not walking out to the parking lot where my cell phone might have a bar or two of service. Just grab my work phone and dial, long distance be damned. She's not the type to get dramatic about serious things, and from the terseness of the email, I know it's serious. Serious enough, as it turns out, to bring her to Johns Hopkins a for a consultation with a neurosurgeon and a neuro-oncologist. Her appointment is next week, and she needs a place to stay, a staging ground for the first battle of this war on cancer, and there was no way in the world I could say no to her. I just hope that my home is comfortable enough for her and her family. I need to wash some blankets for them, I need to clean the kitchen.

****

Everything is ready, and they're here. Big hugs at the door. They're so tired. I've never met her sister before but she's wonderful. She's going to be vicious against this tumor, I can tell. She's got names, numbers, appointments lined up with everyone who is anyone in neurooncology. It's a tense night, though, and I can see that Leila is scared. I wasn't going to go with them to Hopkins in the morning but I ask if she wants me to call in sick so I can be with her and all she can do is nod and bite her lip, and I hug her so hard and I don't want to let go. How dare this happen to her? Cancer has no right to hurt her, to scare her, to threaten her.

****

The doctors are kind and the best in the world. They have decided that surgery has to happen, as soon as possible. Next week. It's growing, and it needs to be stopped. Everyone is optimistic about the surgery because the tumor is in a safe, quiet place in her non-dominant hemisphere, and her language, coordination, intelligence, and personality should all be spared. Thank goodness. The MRI images are up on a glowing screen, and the neurologist scrolls back and forth, back and forth, showing us all of its dimensions. She asks him which colleague he would want in his brain if it was his tumor, and he only hesitates a minute before giving us a name. Within ten minutes, this world renowned neurosurgeon is in the room talking to Leila and making arrangements. He's not the one we came to see, but he's more experienced, and none of us want a beginner to work on this case. He looks like Bill Nye the Science Guy. He makes a rocket science vs brain surgery joke in reference to Leila's physics degree. I like him.

****

It's a beautiful day. A gorgeous sunny day, and she's on a cold table, under bright lights, with her brain exposed under the hands of a surgeon. It's obscene, to have horrible things happen on pretty days.

****

Surgery was a success. She's still herself, answering questions and then demanding answers of her own. Did they get it all? Were there complications? What grade is it? Define this enemy so we can fight it. I can't get to her while she's in the hospital and I feel guilty, but I'm at work at my own hospital's blood bank where we're down two employees and trying to keep our own patients alive, and the visiting hours are short and impossible for me to make use of. Her sisters are with her, and they are keeping me up to date. They're not giving her enough pain medication, not giving her anything for sleep, for anxiety, because they are waking her up for a neurological exam every hour or two and the drugs might mask complications. It's barbaric. You were inside her head. You cut through her skull. Let her sleep. Let her heal. She will need her strength to fight.

****

She's out of the hospital so quickly I think it can't possibly be safe, but she will sleep better, eat better, here. The verdict is in and it's a terrible enemy to be fighting, a Grade 3 astrocytoma. Hard decisions must be made about how and where to start the next steps. Now comes the radiation, the chemotherapy, the nausea, the weakness and the wigs. But who can she trust with her life, with her brain, her mind? There are so many drugs, so many new clinical trials with so many risks, and so many experts willing to take her case. How can a person make this decision?

****

I have known and loved this woman for years. We went to school together and we've always stayed in touch. She's 31 years old and speaks three languages, plays the piano, and has explored a dozen countries in hiking boots by day and 4-inch heels by night. She loves horseback riding, French literature, Sex and the City, and ballroom dancing. She wrote a mystery novel and is editing it to submit it for publication, and she's supposed to defend her thesis in November for her PhD in nuclear physics. She has never said no to any crazy adventure. She's loud, sexy, and unapologetic, and charms her way into and out of all sorts of trouble. And now she's fighting for her life, because some tumor decided to make itself comfortable in her beautiful brain.

I'm sad. I'm scared. I'm angry. I know it's nothing compared to the amplified emotions she and her family must be feeling, but she's been at the back of my mind since that phone call and I know that I will think of her every day now as she fights this astrocytoma. Fuck cancer. It's not fair.

She's trying to raise funds through an online program called FundRazr, to help pay for the medical treatments that are not being covered by her insurance. I'm sharing the link here not necessarily in hopes that you will donate, but in hopes that you can share the link with others and help her that way. She has also started a blog to tell her story, and I think you should read it. Please share it.

Instinct in a crisis

When faced with people who are grieving, bewildered, or upset, my instincts go straight to food. I must feed these people in their time of need. Maybe it's a learned behavior, but it's so ingrained that it's almost completely automatic. You are crying. I will make you banana bread.

A good friend is going through some very bad things including a terrifying surgery, and some of her family is staying at my house because I couldn't let them all pay for a hotel when I live so close to the hospital and can offer them a comfy bed, free internet and TV, and three purring cats. When I learned that they were coming, I went to the grocery store. Yes, I also cleaned the bathrooms and got the extra blankets out, but the food was so important. Unfortunately, they are the type of people who have no appetite when they're under stress, so I'm at a loss. I'm becoming a pushy European grandmother, offering them food every hour or two, trying to get them to eat. Maybe just a smoothie? Nothing? Well at least let me show you where all the food is in case you change your mind later... and of course if I hear you rustling in the fridge I will come running and assemble that sandwich for you. The words "you need to keep up your strength" actually found their way out of my mouth. I am 30 years old and I have evolved into a bad cliché.

Food is comfort. Food is love. I'm not sure how else to be helpful.

Jam!

I got jam in the mail this week! How cool is that?

There was a giveaway on my pal Tasha's blog, and I won homemade jam! A jar of 3-berry jam and a jar of blueberry-lime jam arrived this week in a shredded-paper-filled box which the cats have adopted as a new nap space.

Seeing those cute little jars really makes me want to learn canning. Not just for jam, but for sauces and soups and all sorts of things. I have a finite amount of freezer space and it would be great to be able to have shelves full of tasty homemade things I could pop open when I needed them. The trick is avoiding botulism.

Anyways, back to my jam review.

It was awesome. I was sad that I didn't have any english muffins handy to slather with tasty jam, but the week-old multigrain bread toasted up pretty well and I jammed the heck out of it, over a thin slick of butter, and it was so, so, so good. I opted to start with the blueberry-lime - a little more limey than I expected, and also not as tart as I expected. Not sure how both of those things managed to be true, but there you have it. The jam will not last, because it will be devoured. And I really need to buy english muffins.