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.

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.
 

K-cup Vivisection

Things got a little brutal yesterday at work.

I've moved up in the world and now work in a place with a communal Keurig machine in the break room. Everybody buys their own K-cups, so there's no fighting over who paid how much for their coffee dues, and we all get to make our favorite flavors. Heaven. Seriously. It's the small things.

After spending too much money on K-cups, my coworker and I each picked up one of those DIY-K-cups from Bed Bath and Beyond (with a 20% off coupon, naturally). The packaging says you just fill it with your preferred ground coffee and pop it into the machine for a delicious cup of coffee for a fraction of what the official K-cups would cost you.

The thing is, we can't get it to work. We get coffee, yes, but it's terrible. Even filling it to the absolute maximum line and setting the Keurig for the smallest cup (6oz), the result is extremely weak. We've tried putting more coffee, less coffee, finer and coarser grinds, and different brands of coffee, but it always comes out like a cup of watered-down coffee. Watching the process closely to pinpoint the problem, I noted that the liquid coming out of the Keurig with one of these things in place was a lot lighter in color than when a K-cup was in there, so I put in a K-cup (since I wanted a decent coffee!) and watched the machine to confirm my suspicion. Sure enough, the coffee looked dark at first, but gradually got lighter until it looked as watery, right at the end, as the stuff coming out with the Solofill cup.

Hypothesis from the peanut gallery in the break room: Maybe the K-cups are super-packed with much more coffee than we could fit in the Solofill! Considering how everyone who walks up to the machine with a K-cup is always unconsciously shaking their little coffee pod like a maraca, I knew this couldn't be true: if it was packed really tight, it wouldn't make noise when shaken. The group wanted proof, of course, so I fetched a sacrificial K-cup from the box of freebies in the office supply closet, which is stocked with decaf and flavors nobody likes. My victim: spicy eggnog. Eeeeeewww.

It was obvious, once I held the pod up to the light of the window, that it was only half full. The interesting thing is, it's the top half that's full, and the bottom is just air. I cut it open to confirm that it was just air and not a filter or something, and yes, just air¹. The top half of the cup was taken up by a thick papery filter full of coffee.

Second hypothesis from the peanut gallery (we have very chatty peanuts in our group): maybe it's not real coffee in the K-cups! Maybe they put instant coffee in there to fool us! The problem with this, though, is that a used K-cup still has coffee in it. Yes, we dismembered one to check. 

New hypothesis! Maybe there's a combination of instant coffee and real coffee in there. This would explain why there is still coffee in the pod once it's done brewing, and explain why the coffee is darker at the beginning, because the water dissolves the granules right away while the rest of the coffee does its thing. My goodness, what a sexy hypothesis! How to check? We tore the lids off the new and used K-cups to compare the volume of coffee grounds, because obviously the instant coffee would have melted away. Weighing them was immediately rejected, because one was waterlogged. Instead, we dumped out some of the dry coffee from the new pod and compared it to regular ground coffee. It looked the same, but just to be sure, I sprinkled some of the K-cup coffee in a coffee cup and added warm water to see if it would dissolve. It did not.

So now we all know what goes on inside a K-cup, but aren't much closer to making decent coffee with the reusable filter. The current hypothesis is that the filter isn't fine enough and the water goes through too fast, not bringing enough coffee flavor with it. Cramming more coffee into the Solofill just causes an overflow problem, so that's not the answer. The paper filter in the real K-cup is very thick, so we're thinking that's the key.

They sell other kinds of multiple-use Keurig pseudo-pods², so the new plan is to buy a couple of different ones and see if they work any better. All of them seem to have similar reviews online, so it's hard to decide what to try, but with our filter hypothesis, I'm going to look for one with a very very fine mesh.

1. I suppose it may have been helium. I did not run it through a mass spectrometer.

2. Pseudo-pods, as in "false pods" not as in "a temporary protrusion of the protoplasm, as of certain protozoans, usually serving as an organ of locomotion". To my knowledge Keurig coffee machines are not amoebas.

Blood bank lesson: blood group antigens

I've been at the new job for a week now, and I'm thinking it's going to work out. I've been asked what exactly I'll be doing there, and I would like to explain, but first you'll need a blood bank lesson or two.

You've got stuff on your red cells. They're little nubbins of proteins and sugars, and we blood bank types call them antigens. They're genetically determined and you inherit them from your parents, so what's on your red blood cells will be a mix of what's on your Mom's and on your Dad's. You're probably familiar with the A and B antigens, since they determine blood type, and the D antigen is the one that makes you "Rh positive". Those were the first ones discovered, a long time ago, and since then there have been dozens more, if not hundreds, added to the list. Scientists, having a deep-rooted need to sort, classify, and name everything, have sorted, classified, and named them all. For some people, these antigens become an issue.

When you get a blood transfusion, you're exposed to a mix of antigens from the donor's cells, and your immune system might decide to make antibodies against the ones it's not familiar with. The same thing happens in pregnancy, because the baby's cells will have some antigens from the father's side, which the mother's body has never seen. There's no guarantee that you will develop an antibody if you're exposed to something new, but once you've made an antibody, we have a problem.

Let's say you get a blood transfusion from someone who's got the Kell antigen on their cells. It's a common one - about 90% of people have that one. If you're in the 10% of people who are Kell-negative, you might make an antibody in response to your exposure. Next time you go to the hospital and need a transfusion, the blood bank will find the antibody in your blood when they do a "type and screen". Once they've done their investigative magic and figured out the identity of your antibody, they will have to find you some blood that doesn't have the corresponding antigen on it, because now that you've got those antibodies in your system, if you see the Kell antigen again, your antibodies will destroy those transfused cells and all the red cell guts will be free in your blood and that's a bad thing.

How do they find the Kell-negative blood for you? With antibodies! There are commercial preparations of purified Anti-Kell (and anti-pretty-much-everything) that the blood bank can buy and use to test blood units. So they'd take a little drop of cells from the donor units, and mix them with this antibody solution, and see if the cells clump up. If they do, the cells are positive for the Kell antigen, and you can't have those. The ones that don't clump up are safe for you, because if this Anti-Kell solution doesn't clump up the cells and destroy them, neither will the Anti-Kell you've got floating around in your plasma (the liquid part of your blood).

Recap: Blood group antigens are on your cells. When you're exposed to a foreign antigen, you can make an antibody that will remain in your plasma, which can make subsequent exposures dangerous. Blood bankers use antibody solutions to test blood for specific antigens, when necessary, to be sure to avoid that situation.

Questions from the class?

New Job, part 2

Apologies to my readers for not giving you anything all week. I'm often saying that there need to be more hours in a day so I can get everything done that needs doing, so I will use the free hour from the Daylight Savings fall-back to feed my poor little blog.

I've got a few book reviews to cover, and a project or two to write about, but I've been too stressed to focus on writing. I told you a little while ago that I'm going to be moving on to a new job and leaving the hospital behind. That was a hard decision, and one that I wavered on. My coworkers were very sad to hear I was leaving them, and I don't think it was all selfish sentiment from knowing they'd have to fill in all the gaps in the schedule. From the day I gave my notice, they've been trying to talk me out of my decision. They didn't use any arguments I hadn't already wrestled with, but hearing them from other people made me very nervous that maybe I was making the wrong decision.

Manufacturing? Really? Sitting in a quiet lab all day with almost nobody else around, running the same few tests over and over and over? I'm so used to doing four things at once and having to keep on top of everything; will this be too much of a change for me? Will I be bored? Lonely? The group of people I work with in the evenings now is really fabulous and I know I'll miss the goofy fun we have between crises. And I'll miss the high I get from zipping around and managing a situation as it tries to spiral out of control, and knowing at the end of the shift that my work contributed to a patient living another day.

But I'm so stressed out right now. And the stress from the actual work, while it will never go away because of its nature, isn't the problem. It's the little things. The doctors calling us liars when we say it'll take half an hour to thaw plasma. The all-caps emails CC'd to my supervisor threatening to "write me up" if I forget to staple paperwork one more time. The resistance to change and growth I encounter from so many people who tend to react reflexively by putting band-aids on problems instead of thinking about the causes and trying to eliminate them at the source.

I guess I take it too seriously. If I was able to disconnect a little more and just go to work and put in my hours and go home, maybe I'd be happier there. But I can't do that. Everyone who works part-time says it's a lot easier to care less when you're not there every single day, and maybe they're right but I can't afford to drop to part-time right now. So I spend more time at the hospital than I do with my husband all week, and I'm invested in that lab and I am so frustrated that it's not as great a lab as it has the potential to be.

I love my coworkers and they're all good techs. The hospital is growing and changing and it's exciting to be a part of all that. My supervisor is great. But somehow, we find ourselves griping and sniping and sabotaging each other out of stress when we should all be patting each other on the back and busting with pride at how awesome we all are for keeping the place running with fewer people and resources than we should have to. There are no fingers to point - everyone is guilty and everyone is a victim. I suspect it's a similar story in every hospital lab in the country, because we're all underrecognized and understaffed and the work is so draining.

So I need to step back. I feel like this job is like a boyfriend with potential - if only he'd apply himself a little more! But the relationship is toxic in its current state and it's time for some space. I'm not happy, and I need a break.

Making the decision was hard. There was no counter-offer from the current job (HR policy), but it's not even about the money. I made list after list of good things and bad things and there were so many unknowns, and every five minutes I'd talk myself into or out of staying, over and over. I might get bored. I might come crawling back in a few months. But in the end, I need to try something new so I can preserve a little sanity. I can't go to part-time work, so I need this new job. And maybe I will fall completely in love with it and never want to leave.

New Job

Well, I've gone and done it. I gave notice to my current employer and I'll be moving to a new job at the end of November.

It's been a long time coming. Evening shift isn't making me happy. Getting home at midnight and trying to figure out what to eat is no fun. I can't take any evening classes at the library or community college, can't call Mom until the weekends, can't ever go out to dinner with friends. I'm tired of being out of step with the rest of the world.

The new job is further away, but it's a day shift with no weekends or holidays ever, a lot less stress, and the lab has windows. This is a big deal to us lab rats, who never see the outdoors. It's a recorded fact that every lab tech ever, upon the arrival of the staff for the next shift, will ask what the weather's like out there. It's not just small talk - we have no other source of information about what's happening in the outside world. I'm pretty sure that we'd keep working through the apocalypse, not realizing that there were rivers of flame coursing through the streets, because we're so sheltered in our hospital basements. Well, we'd know when the next shift called to say they couldn't make it.

I'll be stepping away from patient care and moving towards reagent manufacturing with the American Red Cross. I won't be getting blood ready for surgery and I won't be trying to identify antibodies in patient plasma so I can find them compatible units. Instead, I'll be taking those plasmas with antibodies and purifying them so the antibodies can be used in reference labs for blood bank testing. Very different, and I am a little nervous about getting bored and missing the rush that comes from knowing I just helped keep someone alive, but I think the lower stress will be healthier for me.

I'm terrified at the prospect of being the new girl again and having to start over with a new group of people and a new workload, but this has to happen. I love most of the people I work with at the hospital, and that made it into a very difficult decision for me, but in the end I knew that if I decided to stay, I'd be staying for other people, and not for myself, and that's not a good enough reason to turn down this opportunity. I'm done with being exhausted all the time, so I'm going to try something new and hope it works out.

And if it doesn't, well, there's pretty much always a position open at the hospital for me to go back to, even if I need to start over with something part-time.

Well, I'm back.

It's been a long month. August, I have decided, is my least favorite month. It's too hot, for starters, and then this particular August went and kicked my ass. An earthquake, a hurricane, a friend fighting cancer, a cat peeing on everything, a switch to evening shift, two gradually deteriorating grandmothers, a tree on the house and no power for a week, and a goodbye to my dear Tio. Can I get a break, please?

I survived, which is pretty awesome, but I'm a little worn out. I know other people have it worse and I'm trying to maintain that perspective and not come across as a whiny brat, but it's not always easy. I'm trying to figure out how to make my life work now that I'm back on the evening shift. It makes it harder to stay in touch with everyone back home, because I can't call them at midnight. I'm not quite sure yet how the day-to-day routine will go, because this is the first week I'm doing this for real - first I had houseguests, then I worked a couple of early shifts, then the power went out and I was at my mother-in-law's every night after work so I could eat and shower. So, I guess the learning curve starts now.

Hopefully now that I'm climbing back out from under my dark little cloud, I can keep up with my posts here a little better. That's the plan, anyway. I probably won't bother reviewing any of the books I read over the past month, because just thinking about catching up is overwhelming. Maybe I'll make up a list and then if there's any interest I can expand on some of them.

Blood Bank Regulars

Someone mentioned to me that I need to post more about work and the blood bank, so I'm going to try. I'm not sure what people are interested in, and I don't know how technical to get before they give up and get frustrated and go look for videos of cats on Roombas instead, but I'm going to start somewhere and hope that people comment to guide me.

We have regulars at our blood bank. Safe in the basement of the hospital, where all good med techs belong, we crack jokes about them needing loyalty cards - get a punch for each unit of blood transfused and the tenth unit is on us. We never see the patients - we get their blood, type it and check for antibodies, crossmatch some suitable units from our supply, and send the blood up to the infusion center, the emergency room, or the hospital floors. But even without meeting these patients, we get to know some of them, whether we want to or not, especially those who have chronic conditions that bring them back week after week for scheduled transfusions. Or those with "problems" that make it hard for us to find them safe and compatible blood - when we see an order print down in the blood bank, and we recognize the name, it's not usually good. Impending doom is probably how I'd describe the feeling.

Like Mrs. B, who's up to 550 units over her lifetime and still going strong. She has a bleeding disorder, and her own body can't keep up with the blood loss, so she comes in for weekly transfusions. Because of all of these exposures to foreign blood, she's developed a couple of antibodies, and because of the specific ones she's developed, we need to get her special compatible units from the Red Cross. Sometimes she has a bad bleeding episode and comes in through the emergency room because she can't wait until her appointment, so we always make sure to have at least two units aside in the blood bank, tagged with "Save for Mrs B", so that in a crisis we can at least get her started with something while we get more shipped in from the Red Cross.

Or Mrs. M, who has such strong auto-antibodies that her cells clump together as soon as they come out of her body into a specimen tube, making it impossible to discern her blood type. We have to give her Type O blood because we just can't tease her blood type from her cells and plasma. We tried asking the nurses to preheat the specimen tubes and to bring them to the blood bank on a warmer or in a cup of hot water, but even that hasn't been enough to fix the problem.

One of our regulars passed away recently, and it depressed all of us. We'd been supporting her through regular transfusions for over two years. Over the course of those years, she developed more and more antibodies, making her case a complex one requiring a few hours of work from a dedicated tech each time she'd come in, and specially-typed units from the reference lab at the Red Cross for transfusion. We'd all grumble when we saw her orders come across the printer, and argue a little over who worked on it last time and whose turn it was, but we were all glad to be doing something to help this woman enjoy more time on this Earth with her family. Hearing that she was never coming back was a little hard on all of us.

We don't always find out what happens to the patients, because of privacy rules. Sometimes we suddenly stop seeing a patient, and we don't know if it's because they got better, got transferred, or passed on. It's very hard sometimes to have worked hard in the blood bank to help keep someone alive, and then not know if it succeeded. But by the time you start worrying about it, another patient comes in, so you just keep going.

Shift of Perspective

I enjoy stability. I like routine. A schedule. A plan. I like knowing what is expected of me, where I'm supposed to be at what time, and what I'll be doing there. I don't go so far as to declare Tuesday night meatloaf night for all eternity, but I like knowing I will come home on Tuesdays, check email, and then cook dinner while watching bad TV.

Things are changing at work, and it's forcing me to reset my comfy routines. For over two years, I was working a split shift, where I came in at noon and covered the day shift during their lunch breaks, and left at 8:30 pm after covering half of the evening shift. I loved it because I never had to wake up before the sun did, and I had time in the evening to cook meals more involved than frozen pizzas. But things change, and that position no longer exists.

In December, the decision was made to split the blood bank off from the core lab and staff it separately with two dedicated blood bankers on the evening shift, because the workload was getting to be unmanageable for just one tech. At the time, the evening shift techs, who are generalists trained in all areas of the lab including the blood bank, would rotate stations in the lab and find themselves in blood bank, helping me, one week a month. Unfortunately, because of staffing problems, the reality was that I was often completely alone in the blood bank, trying to do too many things at once, and having difficulty getting anyone to come back and help me because they were also busy and usually short a tech or two thanks to people quitting or calling out sick. I don't hold it against them - everyone was trying to do too much with too little and that's why this big decision was made, for the good of the lab and for better patient care.

We used to have a handful of specimens for the blood bank each night, but as the hospital grew, so did the workload. The emergency room is incredibly busy, labor and delivery is churning out 3 or 4 babies a day, and surgeries are happening later and later into the evening, so having two people in the blood bank all evening makes a lot of sense, and will be better for the hospital and for the poor techs staffing it!

When the change was announced, they asked me if I would go to evening shift, but it wasn't really a choice. My split shift was going to disappear, and the only spot open for me was the new full-time evening shift (created by yanking my shift over by three hours). I considered other jobs, and even applied for a couple, but in the end I decided I am comfy where I am. I like the work, I like the location, and I like most of the people I work with. A day shift position became available and I could have applied for that, but with those hours, there would have been an even bigger adjustment to make. So for better or for worse, I moved to my new shift this week, dreading it because of the disruption of my daily routines. How will I come home and cook at midnight? Will I ever see my husband? I will work all that out in time. I've got plans to use the crockpot more often, or leave casseroles in the fridge with instructions for my man to stuff them into the oven before I get home. Maybe I'll get more housework done in the mornings now. I just need a little time and it will all smooth out.

Yesterday was my first shift, and I am now sure that I made the right decision. It may be rocky for a while as I figure out what to do with myself all day, but the evening shift techs hired to work by my side are excellent techs with more experience than me, and they're also great women I can get along with when we're not busting our butts trying to keep people alive. Also, I had forgotten how much fun the other evening shift people are. This will all work out.

Public Service Announcement

If you or a loved one is ever in the hospital and is scheduled for surgery, please ask your nurses and doctors whether the blood bank has an in-date specimen in case you need blood.

Most surgeries won't even be big or bad enough to need blood, and most of the time everyone's on top of things and the blood bank has a "type and screen" on surgical patients long before they make the trip down the OR hallway. But sometimes, especially when it's a patient who's been in the hospital for a few days already, they can end up on the OR table, needing blood, and the blood bank has to tell the surgeon they can't have it immediately because the old specimen is expired. Trust me, that's no fun for anybody. Least of all the poor patient.

And when I say a specimen is expired, I don't mean it's gone moldy or anything. But your body is not static. Every single unit of blood you get challenges your immune system, and increases the chances that you'll form an antibody against a foreign protein on donor cells. So we ask for a new specimen to be drawn every 3 days, so we can catch any changes and detect antibodies before we give you incompatible blood. Blood that was fine for you three days ago might not be fine for you now, if your immune system made an antibody against something in it.

Antibodies aren't necessarily a big deal. In the majority of cases, we can still find compatible blood pretty easily, but the problem is time. A normal type and screen, where we confirm blood type and screen for antibodies to red cell proteins, takes a little over 30 minutes. Once we have that done, adding on units of blood takes 5 minutes. It's really that fast - once the OR calls to ask for blood, we have it ready before the tech shows up at the door to pick it up. But in a situation with a new antibody, even the simplest work-up will take over an hour, and most of the time it's a little more involved. We have to test the plasma against a panel of known donor cells to figure out what specific antibody is present, then we have to pull units from our supply and type them for the corresponding antigen - only those that are negative for that antigen will be safe for the patient with that antibody. That can take up to a half hour. If there's more than one antibody present, the typing takes longer, and sometimes we need to ask the Red Cross reference lab to check their rare donor stash to find us some blood and send it to us, which takes hours. Once we have the right kind of units, the crossmatch itself takes 20 minutes.

Imagine trying to do that, under pressure, knowing the patient needs blood now. When we have advance notice and get the specimen early enough, we always set up extra blood on antibody patients so it's there quickly if it's needed. In a desperate situation the doctor can opt for uncrossmatched units, which can be risky, but the doctor weighs the risks of not transfusing vs the risk of the patient having a reaction, and makes that call. Obviously, we all hate the idea of uncrossmatched blood in principle, and we try to only give patients the safest blood possible after crossmatching it. So we like to avoid unnecessary surprises, like when a patient gets all the way to the operating room for a major surgery without anyone checking on the blood bank.

Be your own advocate, and ask. Worst case, you'll irritate a nurse or doctor. Best case, you'll be sure you won't get in trouble mid-surgery because the blood bank needs a couple of hours to find safe blood for you under pressure.

Lab Week

Photo credit: ASCP

Next week, April 24th-30th, is National Medical Laboratory Professionals Week. It doesn't mean a whole lot to the rest of the world, but it's supposed to be a week to celebrate the contributions of laboratory professionals in healthcare. Mostly, it's confined to the hospital, and we have silly contests and potluck dinners and there's a blurb about the lab in the newsletter. We have fun and then go back to work.

But I see Lab Week as an opportunity to educate. The laboratory profession is a very anonymous one - we're hidden in the basements of most hospitals, patients and families never see us, and yet we affect their care so much. Medical technology schools are closing down due to low interest, yet the profession is due to lose thousands of people to retirement in the next few years. It's a sure bet for a job, in one of the few fields that's actually growing, and yet very few people are aware it exists. Most of the other allied health professions have a similar visibility issue, so we're not alone... but I feel like as a group, we need to make ourselves more visible and get noticed.

So this year, for lab week, I made a slide show about the medical laboratory profession. I toured the lab and took pictures of my coworkers in action, and showed the many things we do in the lab every day, and made a quick movie out of it. I am proud to say that my work will be made available on the hospital's intranet system for everyone to look at. I'm a little nervous because it's just a dinky Powerpoint show, since I don't have any skills past that level, but I hope it helps to inform some of my hospital coworkers about what happens to the tubes of blood once they get stuffed into the pneumatic shuttle system.

I'm currently trying to tweak it to share it on YouTube so my friends and family can see it, and hopefully I can get that done over the weekend, in time for Lab Week.

April Fool's Day

I managed to prank a coworker yesterday, but it was pretty tame as far as April Fool's pranks go. I chose the one guy I have a jokingly antagonistic relationship with because I figured he'd be most likely to find it funny and least likely to retaliate or get me in trouble.

I took all the pens out of his lab coat and unscrewed them to take out the ink cartridge part, and then put them back together. They still looked and felt like normal pens but clicking the end wouldn't get the tip out to write with. Then I swapped out the extra-large gloves he always keeps in his pocket for a handful of extra-small ones, since they're the same color and the switch wouldn't be obvious right away. Then, the decoy prank, where I tied a knot in the sleeve of his lab coat. Because the best ones are the pranks you think are simple but end up having layers. Someone else wanted me to fill his lab coat pockets with lotion, but I thought that was a little much, not to mention incredibly messy!

The online jokes were a little sub-par this year, although I did enjoy going to YouTube's 1996 page and watching a "brand new" episode of the X-files. Ah, 1996. I'm so old.

Anybody get pranked this time around? Or pull off a good one yourself?

Some interesting and important facts about blood

March is Red Cross month, and the hospital is hosting a blood drive (as we do every two months). As the blood bank's donor recruiter, I have to try and raise awareness and interest and get people to sign up to donate blood. This time, the hospital management is getting more involved because it coincides with a new charity campaign they're running, so I was asked to write up some "interesting facts about blood" that could be used in our weekly newsletter and on our intranet page. I want to share them with you, and also encourage you to try donating blood - it only hurts a little bit and you're helping save lives. I see the other side of it all the time, with patients desperately needing blood and platelet transfusions, so I can tell you, it's important. Blood can't be manufactured (yet - research is making strides) and needs to come from donors. Plus, you get cookies!

Blood Facts

The very first blood transfusions were back in the 1600s and involved transfusing small volumes of sheep's or calf's blood to sick patients. Because the blood was from a different species, the patients often had fatal reactions to the transfusions. By the 1800s human blood was being transfused to patients, but because the blood would clot quickly outside of the body, the blood could not be stored, and had to be transferred directly from donor to recipient. Many of these transfusions still resulted in the death of the patient, until blood groups were discovered by the Austrian scientist Karl Landsteiner in 1901. After that point, blood types could be matched for transfusions, greatly reducing the risks.

In the 1930s, The Soviet Union was the first country to establish a system of blood banks, after discoveries showing that adding anticoagulant to blood allowed it to be stored outside the body, in refrigerators. The first American hospital blood bank was established at Cook County Hospital in Chicago in 1936. Blood was stored in glass bottles until plastic blood storage bags were developed in the 1950s.

There are four main blood types, defined by what type of antigen (carbohydrate and protein structure) is present on the red blood cells. There are two antigens: A and B. Those with the A antigen are type A, and those with the B antigen are type B. If your red cells have both, you will be type AB, and if you have neither, you are type O. The blood types are genetically determined and their distribution varies in different populations, but in the United States, approximately 44% of people are type O, 42% are type A, 10% are type B, and the rarest blood type is type AB, in only 4% of the population. Whether you are, say, O-positive or O-negative, will depend on whether you have the Rh factor, another important antigen on red blood cells. If it is present, then your type is "positive", and if it is absent, your type is "negative". Only 15% of individuals are Rh-negative.

The immune system of an Rh-negative mother who is carrying an Rh-positive fetus can become sensitized to the Rh factor, which can create problems with subsequent pregnancies. The result is babies being born with hemolytic disease of the newborn (HDN), where the baby's red cells are being destroyed by the mother's antibodies, leading to dangerously high bilirubin levels and anemia. In 1968, the first dose of "RhoGAM" was given to an Rh-negative pregnant woman - this product can prevent the mother's immune system from being sensitized, greatly reducing the risk of HDN. Blood and Rh typing is now part of normal prenatal care, so that all Rh-negative pregnant women can receive a protective dose of RhoGAM or an equivalent product.

Before blood can be transfused, the recipient will have a "type and screen" done. This test takes approximately 45 minutes and will determine the patient's blood type and check the patient's plasma for any antibodies to other blood groups. This ensures that the patient is receiving compatible blood. The "crossmatch" is when a drop of donor cells is mixed with the recipient's plasma to check for compatibility. If it is compatible, the donor unit is labeled for the patient and can be transfused.

In emergency situations, a blood bank can issue uncrossmatched blood. This happens when the patient's history and blood type are unknown and there is no time for testing before the blood is needed. In these cases, O-negative blood is always given, because it is compatible in recipients of any blood type. Once the patient's sample is available for testing, the blood bank will complete the work and make sure that no unexpected antibodies are present, and then prepare more units for transfusion that are of the same blood type as the patient.

Most blood collected in donor centers today is split into its components, rather than being transfused as whole blood. This is more efficient, because patients receive only the components they need, and one donation can save more than one life. Blood is spun in a centrifuge and separated into red cells and plasma. Red cells are used to treat anemia and blood loss, and help improve oxygen delivery to the tissues. Plasma contains clotting factors and is often used to treat hemorrhage and to quickly reverse the effect of anticoagulant medications. Other elements that can be separated from a blood donation are platelets, which are necessary for clotting, and cryoprecipitate, which is a concentrate of clotting factors.

Platelets are small fragments in the blood whose role is to form clots and stop bleeding. The average lifespan of platelets is only a few days before they lose their potency, which means that they are unable to be stored for an extended period. This is why platelets are often in short supply - donations must be steady to ensure their availability.

The American Association of Blood Banks estimates that 9.5 million volunteers donate blood each year, 20 percent of whom are first time donors. According to the 2007 National Blood Collection and Utilization Report about 16 million units of whole blood and red blood cells were donated in the United States in 2006. Every day in the U.S., approximately 40,000 units of blood are required in hospitals and emergency treatment facilities for patients with cancer and other diseases, for organ transplant recipients, and to help save the lives of accident/trauma victims.

Hopefully I've taught you something today... As usual, I welcome questions about the lab and the blood bank! For questions relating specifically to blood donation, like eligibility criteria or what to expect when you arrive, I'll refer you to the Red Cross website for first-time donors. Please consider donation, or at the very least spreading the word and asking someone else to donate. It does make a difference.

A day in my blood bank life

My day started with an antibody problem. A double antibody, actually, but luckily for me only one of the two was showing up, which made my workup much easier. I got that done quickly enough that I only delayed my dinner break by half an hour, so my tummy rumbles didn't deafen anyone. My coworker helped out while I was on break by typing 8 units to look for compatible blood, but only one was negative for what we needed, and the patient needed three units set up, so when I got back from my break, I had to phenotype the rest of the units on the A-negative shelf to find some that we could give this patient - I could have called the Red Cross for units instead but it's cheaper for us to do it.

While that's happening, STAT specimens are coming in from the emergency room. Some are pregnant women who are bleeding, and they need their blood type to see if they need a shot of Rh immune globulin. Some are GI bleeders. Some of them are cancer patients whose blood is delpeted after chemo and they need a transfusion because they're weak and having trouble breathing. I'm doing my best to prioritize as they're coming in one after the other. Things marked "routine" are sitting in the rack, waiting until I have time to get to them. I'm also in charge of all the rapid testing for influenza, mono, strep, and RSV, and we're in full blown flu season so those swabs are starting to pile up. While my latest type & screen is incubating, I start a batch of 3 flu and 2 RSV, and then a few minutes later they bring me a new handful of swabs so I set up 2 streps and another flu - now I have several timers set for different tests, so things are beeping everywhere. I hate beeping.

So, while I'm calling a positive flu result to the pediatrician in the ER, someone shows up to get plasma on a patient. I don't see any thawed, so I look up the patient in the computer - no, nobody called to say they wanted a unit of plasma, so I need to call the floor and tell them it'll be a half hour while it thaws. I pull a unit out of the freezer to thaw, and oh, now my timer's going off for my type and screen, so I need to move that to the centrifuge. Oops, forgot to put that flu result in the computer. And looks like those strep tests are done too, better result those. And there are two papers in the fax machine asking me to add on more units to a couple of patients.

Phone's ringing, now a patient in critical care is crashing and they want 2 units NOW and then 8 for the OR because they're wheeling her down the hall to surgery almost as we speak. Yessir! I'm on it! Once I find the specimen in the fridge, I see there's not much left, those tubes must have been only a quarter full when we got them yesterday. I can crossmatch 6 units, tops, before I run out of specimen, and that will leave them stuck with needing to get a new specimen in the middle of surgery. I tell the nurse I'll give her those 2 units now, and she should get a new specimen right afterwards so I can get ready for the OR. She agrees and hangs up. So I go back to working on another ER Stat and those two add-ons, and they call back to say the Dr does not under any circumstances want her redrawn now. Get as many as I can ready and he'll make do. I don't like this idea, but there's not much I can do other than document that this was his call and he's aware of the situation. So I get those ready while I get back on the phone to call Labor and Delivery with a result on a baby's cord blood. I have to talk fast because the printer paper that my unit tags are printing on is about to flip over and get crunched up and jam, so I need to get over there to rescue it. Oh, and the plasma's done thawing and the thawer alarm is screeching at me to tell me so.

Now the OR calls. The anaesthesiologist wants to know how much blood we have ready for a patient. Well, we don't have any because we don't have a specimen on him. The doctor's confused, because the patient is wearing a blood bank armband, so how do we not have a specimen? Well, it turns out that when I called the emergency room yesterday to tell them their specimen was too hemolyzed for me to use, nobody bothered to cut off the armband. So when he went upstairs, they assumed he had a valid specimen. So here he is about to get cut open and because he's got an armband on, they figured everything was ok! It happens, it's not the end of the world, I told him to get me a new specimen and we could have stuff ready for him within 45 minutes. But he was upset (rightly so) and was asking all sorts of questions about how this could happen. All I could do was apologize and tell him we can do it in 45 mins. Over and over again.

And the pediatrician is calling, asking for RSV results on a sick kid. A test I haven't had time to set up yet. Sigh. More apologies, promises to get right on it. I feel terrible, because I know that if they're calling it's because there's a very sick kid out there waiting for the right diagnosis and treatment. Then the OR calls about that first patient, asking if I have the 8 units they need... so I have to tell the whole story again and make sure they know I'll need a new specimen if they go through all six units.

And I really, really have to pee.

So, this wasn't just a post to vent about how hard I work or how stressed I am - plenty of my coworkers work just as hard, and not every day is like this. I'm just trying to give a picture of a busy day and open this blog up to questions from the audience about what I do. The hospital lab and blood bank are mysterious hidden places, and most people have no clue what goes on there, or why. so if anyone has anything they want to ask about the lab, the blood bank, or about blood or medical testing in general, please ask in the comments, and I'll take the time in future posts to address them all.

Christmas decorating contest at work

My hospital gives out annual prizes for the best-decorated department, and for the best-decorated department door. It's not much, maybe $50 to spend on a pizza party for the department, but it's still a ton of fun to waste a day or two gluing sparkles to your door instead of working. Everyone gets really into it, gluing all kinds of things to their doors - last year the blood bank had a cardboard chimney on the door with stuffed Santa legs sticking out. This year, the Transport department is allegedly showing off a 3-D carousel with flamingoes, bears, and penguins... I have not yet confirmed this rumor but I'll head down there Monday to see it with my own eyes.

The deadline was getting close and nobody was feeling into it this year, so I went to the bosslady with a cute and lame idea, and she told me to go for it. She gave me the bottom half of the door, because she wanted the top half to do something else she was thinking about. I bought a giant roll of shiny silver wrapping paper to wrap the entire door, so we could have a festive base to work from. That was the hardest part because you really need two people, preferably tall people, to hold up the paper and tape it in place - luckily there are some tall people on evening shift who I recruited through begging. Then I taped my wonderfully lame idea in place and called it a night. Actually, the taping took me about two hours. I kept poking my head into the blood bank to ask if I was needed for real work, but they kept telling me all was well, so I kept taping.

Here's the door:

See how I used the hospital's name for a subtle kiss-up effect? That's how you get points with the judges! Either make them go "awww" or poke them in their hospital pride. Like I said, cute and lame. I like it. Cutting out those letters was a ridiculous pain, and I had to stick them on by putting tiny little rolls of tape on their backs, so the tape wouldn't show. The big letters are cardboard cut outs, and I wrapped them with another metallic paper.

On top the writing says "we dedicate our work to the men and women of our armed forces and their families." Santa later acquired a small American flag to hold.

It's not much, but it was fun to do.

Teaching?

We had a bunch of students come visit the blood bank today, on a "career exploration" field trip to the hospital. High school students, I assume, but I'm getting worse at judging the ages of the young as I'm getting older. Which is depressing, if I stop to think about it. So I won't.

Normally the boss lady takes them around and shows them the workings of the blood bank, but she was in a meeting and we were caught off guard with only a 15-minute warning before the youngsters' arrival. So the job was handed to me, in that everyone else basically claimed "not it" and disappeared.

I really enjoyed giving them a tour and teaching them a little about blood banking and transfusions, and how important the work is. I explained about blood types and why O is the universal donor, and I explained what the different parts of blood (platelets, red cells, plasma) are used for and why. I told them about quality control and attention to detail and why that's so important in a lab. They asked a bunch of good questions, and some of them were taking notes - I've never seen anyone in the other groups bother to take notes! At the end of it, the teacher caught my eye and told me I did a great job, and I should consider teaching. If only she knew how often it crosses my mind!

I've thought about teaching, but I'd never make it as an elementary or high school teacher, and I'm not sure I have the right stuff to teach college science classes. But I know medical technology stuff pretty damn well and I'd love to share that with students entering the profession. It's not out of reach - the main reason I haven't pursued it as a career is because I want to get some experience in this field before I presume to know it well enough to teach it. Also, I think I might need a master's degree, which is a big deal and not something I can tackle right now. But maybe I'll look into it a little more seriously. Or at least consider tutoring students in the field, as a start.

I just love knowing stuff, and helping other people to also know that stuff. Honestly, this may be a little dorky, but one of the things I'm most looking forward to about having kids is teaching them stuff and watching the light bulb go on above their heads. That little moment of understanding is what it's all about. I'm even looking forward to helping them with their homework. Except the math homework, which can remain securely on Dave's list of responsibilities, because there is no way I'd be of any use dividing fractions.

Sunrise

I had to work a couple of Saturdays and Sundays this month - more than usual because a coworker went on maternity leave and left us with a dozen weekend shifts unmanned. It's not so bad, because there are enough of us that we each had to pick up one extra day and we were covered. Also, her baby is adorable and so I forgive her for wanting to stay home and be with it and stuff. Normally, when nobody is having babies, I work every seventh weekend.

I don't enjoy my working weekends and holidays because they're always day shifts, meaning I need to be there (and preferably awake) by 7am. So I need to be up by 5:30am. Compare this to the normal noon start to my shift, and my alarm clock's usual setting of 9am. It wouldn't be so bad if I was able to get some sleep the night before, but I'm a nocturnal creature and I usually have to take an over-the-counter sleeping pill to help knock me out early enough. Otherwise my internal clock doesn't hit "bedtime" until midnight at the earliest. Of course, the side effect of this is a groggy morning and blinky drive to work during which I am thankful I'm nearly alone on the road.

Despite my sleepiness, my journey to work these past two weekends has not been grumpy, because I drive east and my timing has been just right to catch the sunrise. I know that a sunrise looks essentially the same as a sunset, but it feels different. There's something very calming about seeing the light return to the sky, and watching the clouds go from pink to peach to butter to blue.

I totally slept in this morning, though.

Understaffed at work - and why it matters to you.

So, so, so, so tired.

We've been working so short for so long at work and it's really wearing me out. We're understaffed, and someone's been off sick for a month, so we're trying to run things with too few people. We're doing a damn good job of it, but it's exhausting everyone to their limits. Everyone is getting progressively more tired and cranky, myself included (hell, myself's probably the worst one).

I hope it ends soon, but the heart of the problem is never going to go away. It's only going to get worse. Nobody is entering the lab profession because they don't know it exists and medical technology programs are being shut down in schools everywhere. A massive number of seasoned techs are approaching retirement and there are nowhere near enough new graduates to fill the vacancies. You'd think this would mean we're in huge demand, with hospitals offering bonuses and juicy salaries to the relatively few techs out there, trying to entice them. But they're not. Everywhere, everyone is trying to run their lab with fewer and fewer people, cutting costs as much as possible.

This article (worth reading in full) from the American Association for Clinical Chemistry has some statistics about the shortage.

According to the Bureau of Labor Statistics, in 2006 there were 167,000 practicing clinical laboratory technologists, and a projected need for 21,000 more by 2016. “However, in 2005 only 2,079 people graduated from accredited programs, the number of which keeps shrinking,” explained Susan Gross, MS, MT (ASCP), Senior Supervisor, Clinical Laboratory, Chemistry/Toxicology at San Francisco General Hospital and the University of California-San Francisco. “In 1975 there were 709 clinical laboratory science programs with 6,121 graduates; in 2005 there were 232 programs and 2,079 graduates”

The lab is important. So important. Most medical decisions are made based on lab results, and without techs there to run the instruments and read the slides and count the cells, you don't have any results. We are the ones telling the doctors whether you have strep throat or the flu. We see the bacteria and white cells in your urine that tell the doctor you have a UTI. We're the first to see the leukemia cells in your blood. We make sure you have compatible blood available in case your surgery gets complicated.

I know some of my friends reading this blog are also medical technologists (or clinical laboratory scientists, depending on where you're certified). Please get out there and talk about the profession. Sign on at Labs Are Vital and get involved. Tell people who we are and what we do and why it's an important job. We don't have anyone out there fighting for us and singing our praises, so we'll need to start doing it ourselves if we ever want any sort of respect and recognition.

From this American Society for Clinical Pathology article about their Wage and Vacancy Survey:

Exposure and awareness of the laboratory profession has had an effect on recruitment. A recent survey by the Coordinating Council on the Clinical Laboratory Workforce showed that of 4,500 students enrolled in a clinical science program, 75 percent were not even aware of the profession until after high school.

I personally didn't know it existed until after my first University degree in a different field. I am sure that there are hundreds of other students who are like I was, loving science and the medical field, but not wanting to be a doctor or nurse. Someone needs to tell them there are more options!

I'll get off my soapbox now. I promise I'll go back to posting recipes and projects this weekend.