Final rotation

This was the Chemistry rotation, and it left me so burned out that I haven’t even felt like talking about it until now.

Imagine you’re working in a fast-food restaurant. You have to cook the burgers, pour the drinks, operate the cash register and handle the drive-through traffic. At lunch hour. Oh, and if you get any of the orders wrong, someone could die. It was a bit like that.

Chemistry encompasses more tests than any other department, which meant a huge number of samples to process. Like Hematology and Transfusion, Chemistry operates around-the-clock, with huge analyzers that take dozens of specimens at a time and which are constantly working.

Yet it’s not as simple as feeding in the specimens at one end and collecting the results at the other. The analyzers need regular (and sometimes constant) maintenance, cleaning, calibration and topping-up. If one breaks down, it can cause an serious backlog. And as well as running these, the technologists need to do a number of other tests which are few enough in number that they can be handled manually—analyzing sweat samples for cystic fibrosis, running the flame spectrophotometer, pregnancy tests, fecal occult blood tests and so on.

Most of the time, though, I felt as though I was just trying to keep my head above water—or above the flood of specimens. There was no time for the technologists to ask me questions about the theory behind what we were doing. Chemistry can be interesting, and I never found it particularly difficult in college, but towards the end I was so exhausted I was just counting off the days.

And after it was over, there was the qualifying exam to study for. That was on the 16th, and even if I had wanted to get a full night’s rest before it, I was too tense. I probably had reason to be, since the exam was tough, and I honestly have no idea how it will turn out. CSMLS will let us know in four to six weeks, so that’s another month of worrying I have ahead.

Though at least now I can start looking for jobs. For the past nine months I’d been working part-time in a bookstore owned by a psychic, but I quit that when it got to be too frustrating – here’s a link to the story. Things have got to get better from here.

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Microbiology rotation done!

This is the first day in over a month where I’ve felt relaxed.

It’s been the best month clinical-rotation-wise, but it’s also been the most stressful. This is the end of my microbiology rotation, and microbiology is my favorite discipline. My dream day job would be in a micro lab.

So of course I put pressure on myself to do well, to learn fast and to know as much as possible. I did learn a great deal - there was a lot of new information on bacteriology, antibiotics, mycology (the study of fungi) and so on – and the technologists asked a lot of questions to make sure I knew what was going on. The end result was that I did enjoy the rotation, but I also felt as though I was under a microscope myself. I can only hope I made a good enough impression.

On top of that were my two part-time jobs and the need to study for a qualifying exam that’s less than two months away. So I came home exhausted every day – my apartment looks as though it’s been burglarized, with stuff lying everywhere – and I was way too tired to blog.

They let us have today off, which is a great relief. I’ll still be going to the hospital, of course, but that’s for one of my part-time jobs rather than lab work, so it should only be a few hours.

So, what goes on behind the scenes at a microbiology lab?

The lab processes hundreds of specimens on a daily basis. As well as receiving samples from people who are sick, the lab tests screening swabs (to make sure in-patients aren’t bringing any superbugs into the hospital), water samples, and even medications from the pharmacy department. Everything is sent through the front end, where it’s entered into the system and given an accession number.

The people in the front end work like maniacs as a result.

After that the specimen, like a piece of luggage in the airport, goes on to its final destination. Depending on what the specimen is or what the doctor has asked for, it could be sent to the blood bench, the virology department, the screeners, etc. The bottles of blood are incubated and rotated in a large analyzer that looks like an enclosed wine rack. Technologists at the different benches put the specimens on various agar plates to see what grows.

It is always good when nothing does, not only for the patient but for the technologist. If something does grow, that’s when the train of thought speeds up. Is the bacterium a pathogen (disease-causing agent) or just a contaminant which sneaked in somehow? If it’s a pathogen, what tests need to be done to confirm its identity? If it’s a pathogen, is it present in sufficient numbers to report?

If technologists reported everything they saw, they’d be either dead from exhaustion or fired for incompetence.

Once the pathogen has been identified, it moves on to the antibiotic testing bench. I moved too, and spent a week learning more about antibiotics than two semesters in college taught me. What antibiotics is the pathogen resistant to? Is it a superbug? What antibiotics can be reported? The analyzer may tell you that the E. coli is susceptible to tetracycline. But if you report that and if the patient is seven years old and if the doctor doesn’t know any better and prescribes tetracycline, the patient will go through life with discolored teeth as a result.

You have to know a whole lot more than the machines and the computer system (and sometimes the doctors), in other words.

I didn’t get a chance to see the virology department, but that was the only disappointing thing about my experience. I even identified a fungal species correctly on my last day, which was all the better because that was the only day we spent on mycology. But it’s great to come home and rest, to have a long relaxed breakfast rather than bolting it with one eye on the clock and to know I’ve got the whole of the Christmas holidays before the chemistry, the next and final rotation.

It’s pretty good to be blogging again too. :)
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Blood bank

So now I'm in the blood bank, AKA Transfusion Science. Between this, my two part-time jobs, studying for the CSMLS exam in February and doing revisions on During the Fire, I've been too busy for anything else.

But as well as my blog being overdue for an update, I like to describe the behind-the-scenes work in the hospital. So... blood bank.

When a patient needs a transfusion, a sample of their blood is sent to us for a type and screen. Most people know their ABO and Rh type (e.g. A negative, O positive), but pregnancy and previous transfusions can complicate matters. Being exposed to foreign antigens - and yes, a baby's can be treated as foreign by the mother's body - makes a patient's immune system react by producing antibodies, and this can lead to a bad reaction if they're given blood that hasn't undergone further screening. That's another thing the blood bank checks.

Then the blood can be further treated (e.g. irradiated to kill donor white blood cells which might otherwise attack the recipient) before being labeled and allocated via the computer system. It took me a good few days to become at all familiar with the computer system where everything that happens to a unit of blood has to be documented. I've never worked anywhere where accountability and cross-checking were more important.

Which is understandable. Issue the wrong unit and a patient could die. That's another thing the blood bank does - investigation of transfusion reactions, when a patient has a bad response to the blood they've received.

The Transfusion department also handles blood products (platelets and plasma) and recombinant products like clotting factors for people with hemophilia. It's a fascinating place to work, and the staff are friendly. The teaching tech assigned to us, though, is a bit of a prankster. One day I was in the walk-in freezer, getting some immunoglobulin to be issued to patients. The light switch is outside the freezer, so he crept up and turned it off.

I was so startled I swore. Naturally, he thought that was hilarious. Thankfully I didn't drop the bottles of immunoglobulin, which would have been somewhat less hilarious.

Off to work now.
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From blood to worse

The Hematology rotation ended on Friday.

Two-thirds of the way gone, and I feel as though I’m running on empty. Here’s why.

Last week our clinical coordinator at the hospital informed us that there were a couple of part-time positions open at another department (Molecular Genetics), for students to help with administrative work. Date-stamping reports and sending them out, filing and photocopying and so on. I applied and got one of the positions, which was great in terms of getting a foot in the door.

It also pays five dollars more per hour than my Saturday job at the used-book store, so that’s good as well. I worried a lot about my finances after paying the final tuition fees. This job is going to help so much in that regard.

The problem is that after putting in eight hours at the lab and then two more hours of work, there’s nearly an hour’s commute home and I drag myself into the apartment, wiped out. Way too tired to blog, which is why this has been quiet lately.

Part of it was also because last week I was running about trying to get my immunization records in order to fulfil HR requirements, so that was exhausting too, and I ended up catching a bad cold that knocked me out for two days. But I’m feeling a little better now, and hoping that I can somehow survive the frenetic schedule until the end of January. I also really need to study more and keep up with writing.

Still, at least I did OK with Hematology. The next rotation is Blood Transfusion, so I’ll be working with the same substance but running different tests. And on that note, in Japan, it’s a popular belief that blood type has something to do with personality.

Forced to quit after barely a week as Japan's reconstruction minister for remarks deemed offensive to victims of the March earthquake and tsunami, Ryu Matsumoto had an unusual explanation for his behavior -- his blood type.

"My blood's type B, which means I can be irritable and impetuous, and my intentions don't always come across," he said Tuesday after his resignation.

Link

If your intention is to show responsibility and remorse, obviously not.
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Hematology rotation

I once said that the two most challenging disciplines in Medical Laboratory Sciences, for me, were the ones beginning with H. So it’s a good thing I’m getting these over with at the start—and Histology actually wasn’t that bad. The first week of Hematology has left me feeling a little wiped out, though.

Hematology is the study of blood, which is partly why there’s so much more of a workload in this particular lab. Not everyone gets biopsies or Pap smears done, but everyone has blood tests. As a result, techs work around the clock. I’ve been on the seven-to-three shift, but that’s fine for a morning person like me.

For the first week I helped run the analyzer. That does the work of testing the specimens; what the technologists do is to interpret the results. Which ones are significant? Are they consistent with the patient’s previous results? What follow-up work needs to be done? Can a result be released if the analyzer has flagged it? When do we need to call in critical values?

And all these decisions need to be made in seconds. At first I didn’t know how the technologists managed to do that so fast—especially given that the screens are full of information—but towards the end of the week I was getting a little better at it. I also set up further tests with the blood and did all right. Though there seems to be a real scarcity of chairs in the heme lab, so I usually trudged home with aching feet.

On the other hand, I found out that the technologists like to get normal samples to use for comparison purposes, and will give student a meal voucher in exchange for some. And as you guys know, I adore freebies. So I let them take my blood and they let me run it on the analyzer, which was very cool. The technologists also proclaimed me “disgustingly healthy” after seeing the printout, so they might be tapping me like a maple tree in the future.

Next week I’ll be in Coagulation, monitoring all the ways things can go wrong with the intricate systems of blood clotting. That’s OK, but I also found out that the certifying exam I have to take in February will cost $499. See why I love freebies?

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Dyeing and autopsies

Friday was my last day in the Histology department at the Hospital for Sick Children.

Now that rotation is over and I miss it a little, even though Histology was my least favorite aspect of medical laboratory technology. I always felt as though I was memorizing facts about it (a lot of facts) without ever really enjoying the material or the lab work the way I enjoy microbiology.

Worse, after each semester I would promptly forget everything I had studied, meaning the entire process had to be repeated for the next set of exams. Which was kind of depressing.

But the rotation helped a lot. Histology still isn't the most fun I've ever had in a laboratory (that would be the time I had to check on a bacterial culture at a quarter to midnight, so the guy I was dating came with me, and to this day I don't remember if the bacteria were all right). But anyway. When you spend all day working in one field, it's much easier to become proficient in it, and the rotation drew everything together so that all the facts I'd memorized made a lot more sense.

And then I got to see an autopsy.

I've read a lot of Patricia Cornwell's novels - Post-Mortem, Body of Evidence, etc - but seeing the autopsy for myself was... different, to say the least. No description can recreate the sharp smell of formalin, the sweat on your forehead, the sound of connective tissue tearing away, the squishy slippery feel of internal organs. I wasn't sure I would bear up beforehand, but it was all right as long as I didn't look at the face, hands or feet.

Staring at the torso made it easier to think of the anatomy diagrams in my textbook instead. I won't ever want to perform autopsies, but this one was an unforgettable experience.

Finally, on Friday I got a new lab coat because the old one was covered with colorful spots and blotches from all the tissue-staining we'd done during the week. And on Monday I start in Hematology.

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