Business As Usual

Despite the fact that this is my first post in several months, I don’t have much to report in the way of laboratory ineptitude. 

We’re still plagued by idiot leadership.  Our supervisor “Betty” isn’t the type to supervise.  She prefers we all supervise ourselves.  It’s a blessing and a curse, really.  We don’t have to worry about her sticking her nose in everything.  But, we can’t count on her to sort out disagreements amongst lab people or lab people and nurses.  She shrinks away from conflict like a dog cowering from a storm.  It scares her to death.  But, I guess she just fits in with the rest of the crowd.  Maybe someday we’ll pull someone in with some balls to actually stand up for us lowly laboratorians.

Now for a quick numbskull nurse (eh, maybe I’ll try something different next time).  This comes fr0m a fellow co-worker on the night shift from several days ago.  During the middle of the night earlier this week our Electronic Medical Record system unexpectedly crashed.  This doesn’t directly affect us since we don’t deal directly with patient charts, but, it directly affects nurses and their ability to order lab tests.  So, we, in turn, are secondarily affected in a big way.  Here’s why:  During this “downtime” there was a critically ill patient on one of the floors……OMG, a critically ill patient in a hospital?  no way!!.  Anyway, the nurse drew the blood and sent it to the lab.  However, she forgot to put any identification on the tubes so we were forced to reject them and have them drawn again.  Common sense should tell you that we can’t accept blood with no identification on it, as it could belong to anybody.  So, she drew it again.  Again it came down with no label on it.  “Stephanie” called up again and told nurse Ratchet that she was going to have to draw the patient again.  She proceeded to give Steph an earful about not being able to print patient labels because of EPIC being down and what the hell is she supposed to do.  Steph waited until she stopped screeching and told her to get out a pen and write the info on the tubes.  Because if not, then she’ll keep rejecting the blood until it changes.  ~Sigh~  This is what we put up with every night with these people.  Nurse Ratchet finally sent down some labeled blood, and what do you know, we ran the tests and reported them as soon as we could.

In other news, I got married, went on a honeymoon, and bought a house in the last three months.  Life away from the lab is good.

Anal Retentiveness is Vital to the Chemistry Laboratory

Lab people are inherently anal.  We tend to have a bit of OCD and need to be organized and clean.  It’s the nature of the lab.  As long as everything is in the correct place, people are relatively calm.  However, rearrange just one small thing and it throws the entire section into chaos.  I was able to witness this last week after I took the initiative to reduce clutter. 

I had chemistry’s best interests in mind when I did what I did, but not everyone agreed on what the best interests were.  So what was it that I did to bring the entire chemistry lab to a grinding halt, spreading mass hysteria and inciting riots, you ask?  I reduced the number of balance tubes for our centrifuges from approximately 75 to a mere 15. 

Now, for those that don’t know, in order to do our job here in the lab we utilize centrifuges.  Basically, they’re like the spin cycle of a washing machine, but for test tubes of blood.  The centrifuge spins the blood tubes at 3500 rpm for 5 minutes.  This is to separate the plasma/serum from the red blood cells for testing.  In order for centrifuges to work they need to be balanced, if you put a tube on one side you have to have a tube of the same weight directly across from it or you risk having the centrifuge “walk” off the counter-top. 

Anyway, for our 3 centrifuges in the lab we had approximately 75 different tubes we could use for balance.  This is WAAAYYY too many.  If you think about it, you should only need one balance tube for each centrifuge each time you spin it.  Anytime you have an even number of tubes to spin you shouldn’t need a balance tube.  Now, we do have several sizes and types of centrifuge tubes in use so we do need enough to cover each type of tube and we also have to allow for tubes that aren’t as full as they should be.  Even after all of that we should only need a handful of tubes to balance the centrifuge.

So, one night on my last stretch during an uncharacteristically quiet period I decided to sort through our balance tubes and whittle the total down by a few dozen.  I kept enough tubes, I thought, so that we would still be able to function easily and balance all of our centrifuges if they were all in use.  The 50 or so tubes I chose to exclude I put in a box in a drawer underneath the centrifuges, just in case someone really felt they didn’t have enough to choose from. 

I never expected such a negative reaction from the day staff as I received for that little move.  They couldn’t believe what I had done, they were livid.  They couldn’t function without all 75 of their tubes lined up from fullest to emptiest in neat little rows.  Apparently I broke the unwritten commandment of thou shalt not screw with my tubes.  In retrospect, I should have seen this coming from the day shifters, they’re known to be quite anti-change, anti-commonsense, and anti-space saving. 

When I got back from my 7 days off, all of the tubes were back.  Each one lined up in rank, where they’ll sit for the rest of eternity, waiting to be used.  Also waiting for me when I got back were dirty looks and sneers from…. the day staff.  They’re like a gang, they’re all a good 20-30 years older than those of us on the other two shifts and they all seem to band together to fight change and common sense.  I’ve apparently become the embodiment of both of these things and they are none too pleased.  Oh well, I shall continue the good fight and hopefully will emerge victorious when they finally retire.

People Suck

So, this will just be a quick update…..I hope.  At night we only have two people working to cover the whole lab.  One person generally covers chemistry and blood bank and the other generally covers hematology and microbiology.  However, we pitch in wherever we’re needed so that one person doesn’t get completely dumped on.  At least that’s how it should go, and it does most nights.

Tonight was a little different.  It hasn’t been busy, but sometimes something happens that just kind of irks you.  Anyway, it was about 0400 and I hadn’t eaten my dinner yet.  There was a lull after having run my QC and I thought it would be a good time to go eat.  “Maude,” my work partner was sitting out in the processing area shooting the breeze with the blood drawers.  I went in to the break room and opened my sandwich and bag of chips and started reading my book.  Two minutes later, “Lois” calls to me to say that someone’s here to pick up some RhoGam from Blood Bank.  Now, I am in charge of Blood Bank, and I am supposed to be the first one over there to issue blood products and what not, but it’s a simple task and the other person usually has no problem stepping in if the other person is busy.  I considered myself busy, especially since the lab was dead at the moment anyway and “Maude” wasn’t doing anything.  But, she apparently didn’t feel that it was her job to issue some RhoGam.  So, I put down my book and got up and did my job.

You may not think this is a big deal, and, as an isolated event, it isn’t.  But, this type of thing happens all the time, which is one reason I’m jumping the night ship and heading back to the PM shift……whenever they find me a replacement that is.

Quiet……Too Quiet

It’s 0010 (12:10 am) and it’s been a reasonably peaceful night thus far.  No Triple A’s (Abdominal Aortic Aneurysm), no bleeders, no nothing really. 

Triple A’s are fun because the doc usually wants us to set up 6 units of blood for the patient along with a unit of platelets and two bags of FFP (Fresh Frozen Plasma).  And, he usually wants it as soon as he calls and tells us he wants it.  That’s difficult since a routine crossmatch takes ~45 minutes.  This invariably turns into at least an hour and twenty minutes because it takes the nurse 35 minutes to get the order in correctly.  Triple A’s ratchet up the stress but it’s a good stress, it makes time go by faster.

But no such luck, the good people of Madison are seemingly healthy and responsible tonight. 

I guess I don’t really have too much else to offer tonight other than an interesting diagnosis or two.  Whenever a new patient comes in through the ER the admission staff is required to list a diagnosis.  When it’s busy, they don’t have time to search through dozens and dozens of possible diagnoses to find the right one.  So, they tend to just right down what the patient tells them.  We end up seeing them on our LIS (Lab Information System) and some of them are quite hilarious.  We have a running list of the best ones and I’ll periodically share them as I write.  So, here’s one of my favorites.

A patient comes in to the ER and is admitted with the diagnosis of itchy vagina.  This isn’t necessarily a chuckler by itself, but when we did some more lab work on this individual we noticed the diagnosis had changed….. it now read itchy penis.  None of us are quite sure what caused the mix up, but it sure gave us something to smile at.

The Hematology Monster

First up, the hematology stain debacle of 2009.  So, for every CBC (complete blood count) that we get that doesn’t pass muster on our analyzer we have to take a drop of blood, spread it on a slide, stain it, and look at it under a microscope.  This shows us what the red blood cells (RBCs), white blood cells (WBCs), and platelets look like, along with anything else that’s not supposed to be there like malaria and bacteria.

Anyway, several weeks ago we find out that the stain we use is backordered and won’t be available for the next month or so.  “No big deal,” I think to myself, forgetting that this place is managed by idiots.  I figured we’d call one of the other hospitals in the area or one of the other hospitals we’re affiliated with and borrow some from them.  I was wrong, we decided against that.  God only knows why.

We’ve now started “frankensteining” our stain in whatever way we can so the cells look vaguely like what they’re supposed to.  Now, you might think this is all well and good, and what does it really matter?  But, it does.  There are certain rules we have to follow, like validation of methods so that we know that we can trust the results we’re putting out.  Apparently this is one of those times we can skip that part and just go with the flow.

We’ve resorted to using tap water in our stain because that’s what gives us the best looking cells.  For those of you that aren’t privy to lab protocol, using tap water is akin to using toilet water when boiling noodles for spaghetti dinner.

The worst part of all of this is the fact that our “lead tech” doesn’t see this as a problem.  She thinks it’s fine and that we just have to “make do.”  Our supervisor says to, “leave her alone, she’s doing the best she can.”  Yeah, tell that to the patient whose CBC we’re playing blood cell russian roulette with.

Welcome to the Lab

Well, yes, hello world.  This is my first attempt at a blog, so hopefully I’m not too abysmal at it.

Anyway, my blog is primarily going to cover what life in a clinical laboratory is like.  I work at one of the hospitals here in Madison, WI.  I won’t reveal which one as most likely I’ll be airing some frustrations on here and I don’t need anyone coming down on me for it.

Our lab, like every other hospital lab is open 24 hours per day, 365 days per year.  The lights are never off.  I can only imagine what the electricity bill is like for this place.  I work third shift which, for me, is 9:00 pm to 7:00 am.  I’m on a 7 on 7 off schedule, which is nice, but working 7 10 hour days in a row can be draining.

Basically, my job consists of running tests on absolutely everything that the human body produces, excretes, leaks, hemorrhages, and everything that can possibly be cut out surgically.  There are many areas to the lab, but I’ll only be focusing on the 4 that I deal with on a daily basis.  Hematology, which also includes Coagulation and Urinalysis, Chemistry, Blood Bank, and Microbiology.

Hematology is the study of the cells contained in the blood and, occassionally, other body fluids.  We can tell you how many red blood cells you have in your blood which can tell the doctor if you’re anemic.  Coagulation is the study of how a person’s blood clots.  In urinalysis we look at, you guessed it, urine.  Surprisingly, there is a lot you can tell by looking at a person’s pee.

In chemistry the vast majority of our specimens are blood, however, we do get some urine and some body fluids.  We run tests for all of the body’s various chemical processes such as sodium and glucose.  We’re the first people to know if a patient is having a diabetic emergency.

Blood Bank deals with transfusing blood and making sure all of the blood we send for patients is compatible.  It’s the most brain centric area because if we screw up even a little we could actually kill somone.  Not a pleasant thought, but it is my favorite department.

Finally, microbiology is where we find out what kind of bacteria you have growing in that nasty red, pussy (pus, you know), swollen wound you have on your leg that hurts like a son of a bitch.  Micro also tends to get various chunks of tissue, and whole toes that we have to grind up so we can put them in petri dishes to grow.

So, that, in a nutshell, is what I do every night.  What I hope to accomplish with this blog is to show people that there is a place for people to work who like medicine and science, but who don’t necessarily want to work directly with sick people.  We don’t get much recognition for the work we do, but it is fun, and we get a unique perspective of how a patient is cared for.

I’ll be updating this frequently with stories, tales of not so bright nurses and doctors, and the backward ways we tend to do things around here.  Please, feel free to ask me any questions you have, I’ll try and answer them as best I can.  Thanks for reading.