Lab Week Q&A - Color coded blood collection tubes

As much as lab week is about celebrating the work of laboratory professionals, I see it as an opportunity to educate people about what happens in a lab. You get blood drawn, and you get results back, but what happens in between? I hope that I do a good job explaining things - please let me know in the comments if there's anything I missed or that you'd like to know more about.

The question for today is:

Wait, are the colors of caps consistent across labs? I seriously always just figured it was an internal thing, and the bar codes on the sides were the important parts of communicating info to other labs if blood had to be sent out there.

I'm going to break this into two parts, about tube colors and bar codes, and address each one in a separate post. I'll start with the colors.

If you've ever had lab work drawn, whether at a doctor's office, a hospital, or an external collection site like LabCorp, you may have noticed that when they take more than one tube of blood, the caps on the tubes are usually different colors. That's because there are different requirements for how the blood is treated and transported before it gets tested.

Common tube colors - from bd.com

Cap color is indeed consistent across labs. More accurately, you could say that it's consistent among the major manufacturers of blood collection tubes. It's possible that the manufacturers are doing this voluntarily, but I suspect there may be a federal entity like the Food and Drug Administration (FDA) involved, since it could hugely affect patient safety. Even if there is no official rule about cap color in the Code of Federal Regulations, I suspect that someone trying to market an EDTA tube with a green cap would find a very grumpy FDA inspector on their case.

Now, EDTA (ethylenediaminetetraacetic acid) probably doesn't mean much to you, yet. I'm here to tell you that it's an anticoagulant, one of many, used in blood collection tubes. Depending on what test is being run, we want the blood to act in different ways. I'll go over the most commonly used tubes and explain what the cap colors mean and what sort of tests each type is normally used for.

Pink or Lavender - EDTA

EDTA tube - from bd.com

Both pink and lavender tubes contain EDTA, which is a chemical that binds with and ties up calcium ions. Because blood needs calcium ions present in order to initiate the clotting process, blood that is collected into a pink or lavender top tube (and well mixed) will remain liquid.

Lavender tubes are generally used for complete blood counts (often shortened to CBC), which includes things like white cell and platelet count, and hemoglobin. This makes sense - if we're trying to do a platelet count, we need the blood to remain liquid, since a clot is going to tie up a bunch of platelets. If a number of blood cells are tied up in a clot and unavailable for the instrument to count, then the count will seem a lot lower than it really is. A CBC is one of the most commonly ordered tests, because it can tell a doctor about infection (high white cell count) or anemia (low red cell count), which are common reasons for doctor visits. You're very likely to have a lavender tube drawn if you're getting lab work done.

The main difference between the two colors is that the pink top tubes are generally bigger, and get spun down in a centrifuge to separate the plasma from the cells. The pink tubes are primarily used in the blood bank, because we run tests on both the cell part and the plasma part of the blood. We could use lavender top tubes, but we like to have a bigger volume of specimen to work with, in case we need to start cross-matching blood for the patient, which will use up the plasma. Also, the rules for labeling blood bank specimens are usually more strict, and having a bigger tube leaves more room to write out the patient's information.

Light Blue - Sodium Citrate

Sodium Citrate tubes - from bd.com

Blue top tubes are used primarily in coagulation studies, like monitoring heparin or warfarin therapy, or looking for clotting disorders before a patient goes to surgery. Sodium citrate, like EDTA, also prevents clotting by tying up calcium ions, but it's better than EDTA in preserving the rest of the blood's clotting factors. The tubes are always the same size, and contain a set amount of sodium citrate. Most coagulation tests start by adding some calcium back in and seeing how long it takes for the blood to clot, so it's extremely important to fill the tubes all the way. An underfilled tube will have an excess of sodium citrate, which will tie up some of the calcium the instrument is adding in, which will make it look like the blood's taking a very long time to clot. If you aren't on blood thinners, and you're not showing signs of a clotting disorder, you aren't likely to see the phlebotomist pull out a blue tube.

Light Green - Heparin

Heparin tube with gel separator - from bd.com

These were the most commonly used tubes in the chemistry section of the hospital lab. They're used for glucose (blood sugar) testing, electrolytes like sodium and potassium, and other important analytes like cholesterol, liver enzymes, and cardiac markers that can indicate a heart attack. This anticoagulant is usually a Lithium-Heparin salt, instead of a potassium or sodium salt, because most basic metabolic profiles (you'll sometimes hear them called a Chem-7 or Chem-some-other-number on TV medical shows) will measure potassium and sodium, and we don't want to falsely increase those numbers with our anticoagulant. We also can't use EDTA, because the calcium would look too low. 

Because chemistry testing is focused on the plasma, the blood is centrifuged to get the cells out of the way. Some tubes go an extra step with a built-in gel barrier, which keeps the cell portion trapped below so that even if you invert the tube, the cells stay put. This makes it easier to aliquot the sample (take small volumes from the main tube for other testing) without disturbing the cells and making it necessary to spin the tube again.

Gold - Gel Separator, No Additives

Gold tube, no additive - from bd.com

In situations where it's okay for the blood to be clotted, a gold top tube can be used. It has no anticoagulant, so after the blood has been in the tube for a few minutes, it will form a nearly solid clot. Once spun, the tube will have cells and serum separated by a gel barrier, which makes it easy to pour the serum off into other tubes for separate tests. These tubes are often used when the serum is to be sent to an outside lab for special testing (anything not done at the lab where it's drawn), because it's easier to pour the serum into transport tubes for refrigeration or freezing, and they're a little cheaper because they have no additives. 

Many labs use these as their workhorse tubes, accepting them instead of heparin tubes for chemistry workups. I don't actually know why the lab I was working in used the green tubes for most of the chemistry - a lot depends on the instruments being used in the lab and whether they have specifications for the test material. If your test's instructions say it needs to be a heparin tube, then that's what you should use, because the results may not be reliable if you use something else. Also, it's better for the patient if we can run several tests off of one tube, and not just to keep costs down. Repeated blood draws can lead to bruising, and if excessive, to phlebotomy-induced anemia. So, if you can choose to use either a green or a gold tube for a certain test, because both are allowed by the instrument's specifications, but another important test in the lab needs to be on a green top, it may make sense to bundle those tests together onto one tube.

Other - Special Cases

Some other colors are out there, but they're used infrequently and you're not likely to see them unless you're having fairly rare tests done. In our lab, dark blue tubes were used detection of heavy metals like copper or lead, because the tubes and interior of the caps were free of trace metals. Red top tubes had no additives, like the gold tubes, but contained no gel separator, so they could be used for some therapeutic drug levels - the gel has a tendency to absorb some drugs over time, so a red top would be more accurate in those cases. Gray tubes were used for lactic acid levels, but some places use them for glucose, because the potassium oxalate anticoagulant in the tubes stops the red cells from using it all up.

While different labs will use the same tubes for different tests, depending on their methodologies, a lavender top tube in one hospital will contain the same additives as one in any doctor's office. It's common sense, really - you don't want a part-time employee who works at two different facilities to get confused and use the wrong tube for a specimen collection, because it's what he's used to at the other job. Yes, it gets looked at in the lab, but we're all human and sometimes a wrong tube can go on an instrument, and since all the instrument does is read a bar code and perform the tests it's instructed to, you'll still get a result, and it may be very wrong. Consistency is key to medical and laboratory safety.

Happy Lab Week!!

Happy National Medical Laboratory Professionals Week!!

Yes, it starts on a weekend. Someone's got to keep the lab running, you know. A hospital lab never closes.

It's a week for celebrating all those who work in laboratories - phlebotomists, cytotechnologists, histotechnologists, pathologist's assistants, medical technologists and technicians of all stripes. Hug a tech this week if you can find one. Especially if it's me. I like hugs.

This past year has taught me some things about my profession. Namely, that not everyone works in a hospital. Obviously, I knew that - in med tech school they told us we could work in all sorts of places. But when everyone who got hired right after graduation found a job in a hospital lab, it was made pretty obvious to me that most of the jobs were in hospitals. I followed the tide and worked in a hospital too, for quite a while. Two hospitals, in fact. I started in a blood bank in a big Montreal hospital, working any shift they had for me, going from days to nights to evenings within a single week sometimes. Then I got to Maryland and worked in a core lab, doing everything a med tech could possibly do, from blood bank to chemistry to basic microbiology and everything in between. But when it was time for a lifestyle change, I looked outside my comfortable box and discovered that a med tech can still be a med tech outside of the hospital basement.

Where I am now is a strange hybrid between a manufacturing company and a blood bank. I'm not dealing with bleeding patients; instead, I'm making products that will be used in reference labs across the country so that people there can do a better job dealing with bleeding patients. It's fascinating and I'm learning a lot, especially when it comes to quality assurance, documentation, and Good Manufacturing Practice (GMP). Almost everyone there has the same degree as I do (plus some extras), and many of them also started in hospital labs. Now, they're submitting paperwork to the FDA, developing new products, performing extensive environmental monitoring, filling vials in a pristine clean-room, and even controlling document distribution. What a different world!

I had applied for a job at LabCorp previously, and that job would have had me running a STAT lab, drawing blood, and even taking patients' vital signs like blood pressure and temperature. For someone who likes more patient contact, a job like that could be a dream. Not so for me.

Looking over the possibilities in the online job listings, I could work in a fertility clinic, doing semen analysis and bloodwork, and assisting in preservation of eggs and embryos. I could work for the Food and Drug Administration in one of their labs, testing products and water for bacteria, or go out and do inspections of other labs. I could work for one of the companies making laboratory instruments, testing them, selling them, or training people how to use them.  I could branch out into computers and work with a hospital's lab information system. I could teach medical technology at a university. I could get an advanced certification and become a manager somewhere. I could work in quality assurance, public health, forensic labs... so many possibilities. I'd need some extra education for some of these, but it's wonderful to know how many options are out there for someone with my degree. And if all else fails, there are always the hospital labs, chronically understaffed and always looking for fresh techs. Even if I'd have to work nights or weekends, I am reassured by the fact that I will always be able to find a way to make a living doing what I enjoy. I'm grateful for that.

This needs to be a thing

Giggling at my husband reading things in silly voices, and a Robot Chicken Star Wars discussion in the Target parking lot, brought about the opinion that Emperor Palpatine as a checkout guy at Target would be goddamn hysterical.

Why? Because this, that's why:

"Take your pen. Sign your name with it. Then your journey towards your transaction will be complete."

This is likely only funny to myself, but I'm okay with that.

Lab Week is Nearly Upon Us!

I've linked to this powerpoint-turned-video before, but in light of National Medical Laboratory Professionals Week coming up on April 22nd, I would like to share it again.

I created this presentation last year while I was still working in a hospital lab. It was intended as an overview of a medical technologist's daily routine, and my supervisors liked it enough that it was shared with the rest of the hospital staff over the hospital's main intranet page. It's not a fancy video with music and sound, because I'm not talented in those ways - I didn't create this, or link to it here or on Facebook, with a goal of self-promotion. If it helps a single person better understand what medical technologists do, then I'm proud of my work and it has served its purpose. If it steers one curious student towards the profession, all the better.

Since creating this, I've moved on to a new career, even though I'm still called a medical technologist. The change in perspective has showed me new sides of the profession and how it's not necessarily all about the hospital.

Next week's posts will be lab-related, in honor of National Medical Laboratory Professionals Week 2012. I would love some reader input and suggestions for topics, because I want to educate folks about the lab, what goes on there, and what it's like to be a part of the hidden side of medicine. So, please, ask me why the phlebotomist really needs all those tubes, and what the colors of the caps mean, or why sometimes they wrap the tubes in foil. Ask me why lab results take so long, and what in the world they're doing with your cup of urine when you leave it behind the little door. I'm interested in all questions, comments, suggestions and ideas.

JoCo Cruise Crazy 2012, Leftovers

Paul's mom, Mrs. Sabourin, has a pirate's bloodlust. When we were on the bow of the ship for the group photo, I was standing next to her for a few minutes, and when I pointed out a small sandy island nearby, she said "Let's claim it." When I reminded her that there there were probably already people living on it, she looked around at the doughy Sea Monkeys surrounding her and declared "We can take 'em".

We met Jonathan Coulton on the first day, enjoying drinks by the Lido pool. He came up to us and shook our hands, after which he told us "There, I just gave you diarrhea. That is why you never shake hands on a cruise ship."

I learned that the appropriate term for people from Saskatoon is "Saskatonians", and calling them "Saskatooners", while hysterically funny to me, is wrong and likely a little rude. But they wouldn't tell you that, of course. They'll just smile politely and judge you internally.

While we were taking our scuba lessons in the pool, a giant iguana decided he was tired of hanging out in the tree, and belly-flopped into the water next to us.

I'm not sure who created it, but a "burn" gesture was born on this cruise. Used when a particularly good burn is issued, it consists of covering your mouth in mock horror and flicking your hand to divert any burn-ricochet that may come towards you, innocent witness to the spectacular burn.

John Hodgman always sat in the same place for every show - a balcony area christened the "Hodge Pod". He sat quite regally in his Pod, sometimes rising and extending his hands in an attempt to zap the performers with Palpatine-esque finger-lightning.

I'm sure there's more, but it's time to put this cruise to bed and move on to other things. Thanks for the good times, JCCC2. We'll always have Aruba.

JoCo Cruise Crazy 2012, Day 7

All good things do come to an end, and so it was with the cruise. Day 7 was our last day at sea, and you could tell people were winding down and starting to feel the crushing inevitability of the Westerdam's return to Ft Lauderdale and our return to a reality without free ice cream, Famous People dance parties, and casual fez-wear.

I completely missed the morning event, because after a week's worth of extremely little sleep, my body would not cooperate and get out of bed after the wakeup call. The thing with a wakeup call is that it has no snooze button. They need to work on that. So, because I was snoring away in my shoebox of a room, I missed Paul and Storm recording a live podcast. I don't feel too horrible about it, because I got to listen to it a few weeks after the cruise and have a little moment of reminiscing while driving to work in bad traffic, but it sounds like the live audience had a blast, and I'm sorry I missed it.

The event of the day was the Big Event - the man, the beard, Jonathan Coulton, live and awesome. People were lining up in the hallways outside the Vista Lounge to get the best seats, but since we were tired, we came later, took mediocre seats, and still enjoyed the show tremendously. JoCo is so much fun in a live show. He had a band with him for half of the performance, which was neat and gave the show more of a rockstar vibe, but I think I liked his solo stuff better, since it's what I'm more familiar with. I'm sure the newer stuff will grow on me, and certainly his new album is spectacular, but I enjoy seeing him onstage with his guitar, with no extra bells and whistles (except for the Zendrum for Mr Fancy Pants, of course).

When his show was done, it was time to start packing and getting mentally prepared for the early-morning disembarkation ahead of us. I had a sad.

We had our Saskatoon buddies come by our shoebox to help us finish off some wine we'd brought aboard, and we had a wonderful evening with them, including our last fancy meal in the Monkey Pen of the main dining room. There was a big goodbye party by the pool that night, the "So Long and Thanks for all the Booze" reception, where we had a last chance to chat with some of the Famous People and mingle with Sea Monkeys, exchanging business cards and email addresses as seriously as little kids exchange information on the last day of summer camp.

That's what it felt like that night at the party, like it was our last night at camp and our parents were coming to pick us up in the morning.

I want to sign on for JoCo Cruise Crazy III, next February, but have to wait and see whether everything lines up right. I'm glad I got to experience this sort of thing at least once in my life, and I'm grateful to Paul and Storm, JoCo, and all the behind-the-scenes folks who made it happen. Even if I never attend another huge nerd boat party, I've got the memories from this one, and I'm happy.

JoCo Cruise Crazy 2012, Day 6

The final two days of the cruise were spent at sea, while the ship made its way back to Florida.

There was a morning show featuring Vi Hart and David Rees, but I was so tired I don't remember very much of it. David Rees read from his new book about artisanal pencil sharpening, and demonstrated some intricate techniques for the audience, then Vi Hart played us some mathematical piano and got people to hop around on stage to demonstrate patterns and symmetry. Both of these people are talented and funny, but I didn't feel like either of their acts translated well to the big stage. I feel bad saying that, because I really did enjoy the performances, but they're both performers who seem to come across better in different media. Vi's blog and videos are wonderful, and I'm sure David's book is very funny, but having them on a huge stage at 9am was an odd decision.

Thanks to popular demand, Marian Call arranged an encore performance for her doting fans, and a few of us squeezed into the Northern Lights disco for an intimate little show. She's stellar live. I hope she comes to this area soon so I can drag some friends to her show and make them love her. Her guitarist, Scott Barkan, also did a solo show for the Sea Monkeys, but I was wiped out and needed a nap more than I needed more music. I'm told I missed a great show, and I hope someone got it on video.

That night, it was the show of Johns. John Hodgman, the Deranged Millionaire, spoke to us about his new book and the end of the world (his new book describes the end of the world, it does not cause it directly). I enjoyed his comedy tremendously - I'm used to seeing him playing a character, on the Daily Show, and he was a lot more real on the cruise and thus somehow funnier to me. After that, John Roderick, from the band The Long Winters, took the stage. He'd joined other performers in their shows here and there, so I felt like we'd already seen him perform, but his solo show was great. I'd never heard of The Long Winters before, but I've got their albums on my wishlist now. At the end of his show, he brought Jonathan Coulton and his band, and Paul and Storm, onstage to join him in The Commander Thinks Aloud, and the performance moved us all to silence.

Finally, after another formal dinner in the fancy dining room, it was time for The 2nd Annual Paul F. Tompkins Memorial Moustache Formal and Feztravaganza. They like long fancy names in JoCo Cruise Land. People were gussied up, drinking free booze, and sporting creative moustaches.


Mine was a simple stick-on moustache, but my husband, already possessing facial hair of his own, opted for a 'stache-on-a-stick. There were moustaches of every conceivable type and color, even some made out of rubbery tentacles. I will need to step up my game for the next cruise. The fezzes were impressive, too, many of them handmade and quite elaborate. Storm (of Paul and Storm fame), wore a fez with a built in percolator, engineered by Grant Imahara of the Mythbusters. I hang my fezless head in shame, and I pledge to have appropriate headgear for JCCC3.

JoCo Cruise Crazy 2012, Day 5 (part 2 of 2)

What a day.

You'd think Day 5 couldn't get better than giving a dolphin a belly rub, but the thing about JoCoCruiseCrazyII was that it kept getting better.

Sunburned and exhausted, we settled in for what was likely the most-anticipated show for both of us. Dave was excited to see nerdcore rapper MC Frontalot, and I was all ears to listen to Wil Wheaton read us some of his stuff. You may recall I was quite excited, and doublequite nervous, about the possibility of meeting Wil Wheaton on this cruise. More on that later.

Wil started the show, reading us excerpts from his books and blog posts, sharing a little bit of himself with an appreciative and responsive audience. I really enjoyed hearing him, especially because I'd read some of it before, and it was good to hear him tell the stories, with asides, footnotes, and emotion. I wish he'd had more time on stage!

MC Frontalot put on a wonderful show, too, but rap, whether of the nerdcore or mainstream variety, has never been my thing. They just go too fast and I miss half of the words and get frustrated, because I am lame. But you shouldn't be like me - this guy is incredibly creative and talented, not to mention very funny in person, and you should at least give his music a listen to see if it's your sort of thing. The audio of the cruise performances isn't very good, so here's a link to one of his songs, First World Problems, on Youtube instead.

And now comes the best part of the cruise, in my mind. Dave and I spent most of our evening with some wonderful people from Saskatoon, drinking far too many Red Stag Derbies in Ten-Forward. By Ten-Forward, I mean the Westerdam's Crow's Nest bar, located on Deck 10, at the front of the ship. Given its location, I don't see how you could expect a ship full of nerds not to find a label-maker to change the name on the ship's maps by all the elevator bays. Also, for reference, here is the Crow's Nest bar, from Holland America's webpage:

And, for comparison, Ten Forward, on the Enterprise:It's uncanny.

Anyway, after racing to the bar to stock up on Red Stag Derbies and strawberry daiquiris before the two-for-one special ended, we hung out in Ten-Forward and waited until karaoke time. Because yes, there were two karaoke nights to be enjoyed on this cruise!

The place was packed by the time we showed up, so we were stuck standing in the back near the bar, barely able to see the stage. We could hear just fine, though, and as it turns out we had a wonderful view of the Famous People hanging out and being silly at the bar. On this night, I was warned in the most serious of mock serious tones, never to get between a Wheaton and his scotch. On this night, I witnessed John Hodgman belting out Harvey Danger's Flagpole Sitta. On this night I saw MC Frontalot and Wil Wheaton sing along to Hit Me Baby One More Time, along with full tipsy choreography. This was the night I decided I needed to be on JoCoCruiseCrazyIII.

JoCo Cruise Crazy 2012, Day 5 (part 1 of 2)

Why didn't the Beach Boys want to take me to Curacao? Is it because they're too lazy to find a good rhyme?* This island deserves to be included in every list of gorgeous tropical destinations set to music. I could have stood on this bridge for hours, enjoying this view. This was taken just outside the site of our excursion for the day, the Curacao Sea Aquarium, home of the Dolphin Academy.

I struggled for a long time about whether or not I wanted to take the opportunity, while in the Caribbean, to swim with dolphins. Holland America's excursions offered several levels of dolphin interaction, from watching a dolphin show at the aquarium, to getting flippers on and jumping into the lagoon with the animals. My biggest concern was whether it's ethical to swim with these captive creatures for our own amusement - I've heard stories about dolphins being mistreated, and I hated the thought of contributing to an unethical industry. I did a lot of research before finally deciding I was comfortable signing up for the "dolphin encounter" at this specific aquarium, which would put me in the water on a platform, with a dolphin trainer bringing one of the dolphins over for a closeup.

We were told not to wear sunscreen because it would irritate the dolphins' skin, but with our skin already as red as it was, we went ahead and put a little on anyway - on our faces and shoulders, mostly. Apologies if we gave any dolphins sea-eczema, but we just couldn't bear to get more burned. After the pre-encounter briefing and signing of the "we won't sue if we die here" waivers, the group was herded out to the lagoon, where we saw a group of splashing dolphins, with their silvery skin, their bottle noses, and their big pink dolphin wangs. Yes, they were rocking out with their... snorkels... out. I'm not sure whether there were females involved, or whether all of the participants were consenting, but to whom do you report when you witness a possible cetacean rape? The trainers completely ignored the goings-on, so it can't have been too unusual, but I can tell you that I spent the rest of the day very very glad that I decided against actually joining these huge horny bastards on their turf. (Their surf?)

Pasku, "our" dolphin, was young, playful, and disobedient, swimming off all the time to bother his favorite trainer, who was working with others across the lagoon. Only three years old, he was already huge, and made of solid muscle. The trainer kept having to whistle and bribe Pasku with fish, but eventually everyone in our group got a chance to meet him, pet him, and "chat" with him. It was really an incredible experience, and I'm so glad I had the chance to do it. The best part was when Pasku rolled over for belly rubs, which apparently dolphins love as much as cats do.

We took some time to see the rest of the aquarium, skipping the kiosk where they sell professional photos of your dolphin encounter for a whole lot of money. I bought a real sugar Coke at the little cafeteria, which was as delicious and refreshing as it sounds. After the taxi van brought us back into town, we shopped for souvenirs but quickly retreated to the Westerdam to nurse our sunburns, which by that time were pretty painful. I would have liked to see more of the city and the island - these 8-hour stopovers are just enough to give you a taste, but it's not long enough to see much beyond the tourist traps, especially if it's your first time.

*I'm going with "Barbados, Curacao, be my lusty beach frau." This stuff writes itself.

JoCo Cruise Crazy 2012, Day 4

Hello, Aruba!

I had no plans for Aruba, because I was a big chicken and didn't make up my mind to sign up for the Introduction to Scuba Diving excursion until it was too late. I was on the waiting list, but Aruba Day arrived with no word that I'd been bumped up, so my vague idea was to hound the excursion staff until someone let me go try on some flippers. When we got off the ship, the cruise terminal was filled with tables to sign in for excursions, so I got my "pretty please" face on, cranked up the politeness, and haunted the Scuba table so expertly that I expected someone to be by with a Proton Pack to dispose of me. They took my name, and told me it was full, and I had to wait past the start time of the excursion to see if anyone didn't show up. I waited, and waited, and as the clock inched past 2pm, they sent my husband off to the other side of the island with the rest of the divers in a brightly-colored shuttle, leaving me all alone.

The surprise and happiness in my husband's eyes as I got off the shuttle to join the Scuba group is one of my most cherished memories from this cruise.

As it turns out, neither of us are Scuba divers. Once I got into the pool and started using the equipment, I was really excited, but I just couldn't get comfortable breathing from the regulator underwater. I was fine with just my face under the surface, but trying to sit on the pool bottom, with all that water over me, and my only air coming from a tank on my back... I freaked out more than I really want to admit. I felt like I could not get enough air, no matter how hard I tried to inhale, and that just got me hyperventilating, which is not good. Dave had issues with clearing his mask, so he ended up not being able to dive, either.

The instructors see that all the time, so instead of making fun of the sissies, they handed us snorkeling gear and let us float on the waves while the real divers poked around the bottom of the sea. I'd never snorkeled before, but it was a breeze, and it was an amazing experience. We were above the Pedernales, a WW2 oil tanker that was taken out by a U-boat in 1942 and whose wrecked middle section was left as a target for the Dutch navy to practice on. It was so close to the surface that I could stand on a section of it and have my head above water. It's been sitting there long enough for coral to start moving in, and little schools of blue and yellow fish use it as a hiding place to avoid predators. I am still amazed at how bright tropical fish are. Also, at how much salt water burns when it's in your nose.

We were in Aruba until late that night, so we had a perfect chance to watch the sunset from the island. We had some drinks at a bar near the water and watched the sky burn orange behind the Westerdam before we headed in.