Moving Day

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

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

Professionalism

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

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

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

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

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

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

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

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

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

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

Hasselback Potatoes

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

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

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

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

Oh, they were pretty!

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

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

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

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

Bookmarked For Later

I have a little bit of a bookmark problem.

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

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

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

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

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

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

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

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

Project: Bathroom Cabinet Hardware

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

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

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

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

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

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

A Part of My Heritage

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

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

I'd like to share one of mine.

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

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

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

That courtyard is my heritage place.

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

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

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

Where Do Babies Come From?

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

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

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

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

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

And they wait.

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

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

And they wait.

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

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

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

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

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

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

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

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

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

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

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

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

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

Cookies

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

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

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

I sat up a little straighter.

"I'm a tough goddamn cookie."

He smiled at me. 

"Yes. Yes you are."

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

He considered my statement for a moment.

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

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

What else can I do with my medical laboratory degree?

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

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

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

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

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

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

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

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

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

Are There Any Questions? (Part 2)

How did you decide to enter this field?

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

What kind of education and training did you have?

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

What additional training and qualifications are necessary for advancement?

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

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

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