Staying Alive for Dead Week

You all know dead week, right? It’s the week before finals.
For me, this is dead week and I am feeling it!

I am a little frustrated because I started this whole blog with the intention of sharing my lab logs to give people an idea of what it is like to work in a medical laboratory. I know this is a topic which needs addressing because when I went searching wordpress for other people writing about it… all that came up is my blog. Imagine searching wordpress for blogs about nursing and getting no results, it’s nuts.

Here’s the catch- I have the logs written and I want to share them but I am concerned about running afoul of HIPAA privacy laws, which are stricter than you might imagine. It is unlikely that a patient would stumble upon my blog and a set of results and recognize them as hers but in a small town it’s not impossible and it concerns me. [Specific] Age is also a protected identifier under HIPAA laws, though male/female is not. (Age and gender are the only identifiers I include in my lab logs because they are relevant to the clinical picture of the patient.)

So I’m working on it. I think I am going to talk to my lab manager and see what her take on it is. The TL:DR is stay tuned for lab logs, possibly.

The last two weeks I have spent dissecting the coagulation cascade and other topics of hemostasis. I have found that most of the diagrams of the coagulation cascade available on the internet are unintuitive and terrifying. When I show people the one included with my textbook, they throw their hands up and run out of my office before I can say another word. I fashioned a new one for myself and I like it better than those available on the net. Please feel free to use it and share it if it is helpful for you.

coagulation cascade

In case you are curious, the software to create charts like this (and the hematopoesis diagram featured in the last post) is called LucidChart. If you are a student or any sort of person who makes charts, likes charts, or wants to organize information in a chart-like fashion I highly recommend LucidChart. It is pretty intuitive, powerful, and has lots of cool fonts- which as a font snob I consider of the utmost importance.

Also neat is that it’s basically free. All of the features you really need to make a chart are free, anyway. There is a paid version which is what I am using because it is free for students. Anyone with an .edu email address can get it- though to be honest the only paid feature I am using is the google apps integration. Not exactly a make-or-break feature but it is useful.

I am now thinking I should write a post about all the cool software I use to do this college thing. Stay tuned- but not on the edge of your seat because I just used my entire free time allowance for this week to write this post!

The only other item of note is that I am now a member of ASCLS. It says so on my resume so it must be true. I am still working out exactly what sorts of benefits this confers to me.

Peace out!

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Divide and Conquer

I have a post rattling around in my mind, about the joys and frustrations of studying a complex science over a tenuous internet connection. This is not that post.

Sometimes I lay awake at night, staring at the ceiling and marveling at the complexity of life. It’s a big, crazy world out there, how can a person sleep in that sort of cacophony?

One thing that constantly amazes me is that every cell in your body has the same genetic code. Each cell in your liver, in your bone marrow, in your eye, in your skin is all spun from the same cloth. Vastly different functions, same “programming”, if you will.
So how do you take one genome and get literally thousands of different kinds of cells? This is the cool part- we don’t exactly know. Savor those words- we don’t know. Of course, we have some idea- it all comes down to so-called stem cells, generic undecided cells that can go on to become many different sorts of cells depending on which cytokines they are marinated in. Scientists are still untangling the specifics but stem cells are ever-present in the public conscience due to manufactured political squabbles over research on embryonic tissues, despite the fact that adult stem cells are showing far more promise.

When I was growing up, “stem cells” were the new miracle drug; with the promise to cure all diseases, heal all disabilities, and royally tick off the religious right all at the same time. As you might imagine, that never quite materialized but new advances are still being made and it’s a very interesting field.

The production of blood cells (red blood cells, white blood cells, and platelets) is through a process of proliferation and differentiation called hematopoiesis. All blood cells are descended from a pluripotent stem cell in the bone marrow, which goes through a series of cell divisions, maturing and changing along the way to become the mature circulating cells we recognize.

hematopoiesis
This is a chart I made for my hematology class which shows the maturation of blood cells. I found that different sources organized their hematopoiesis charts a little different, I chose the method that made the most sense to me. However, not until I scanned it did I notice I missed a cell- can you spot which one?

To Be Needed

I am finally on top of the homework that piled up in my absence while I was on vacation and hoping to get back to posting now.

Earlier this week, a forwarded email landed in my inbox with the subject line, “desperate plea.” I assumed it was one of those chain emails in which Bill Gates will stomp a kitten unless I forward it to all my hapless friends, but in fact it was quite the opposite.

The email was written by a pastor of some apparent influence (given that it made it to me) in his community whose wife is the director of the laboratory in the next town north of where I live. It is a small enough lab that she probably employs under a dozen people and as such, the fact that she has two open positions that she cannot fill presents a serious staffing issue. How much her inability to find qualified staff has to do with the remote nature of the hospital isn’t clear, but here’s what I do know: we do need more med techs. It is absolutely as desperate a situation has the letter implies.

Go into any medical laboratory in this country and you will likely find it is well staffed. Look closer, however and you may notice that the overwhelming majority of staff are older than 45 years old, and many are within years of retirement. We have a looming shortage of qualified medical technologists and the impact on our healthcare system cannot be understated. When these men and women retire, without smart and talented new grads to replace them turn around times will increase greatly, test menus will shrink, and result accuracy will suffer.

You think you have to wait forever in the ER now, imagine what it will be like when every patient that comes in with chest pain/arm pain/dizziness/etc has to be treated with heart attack protocols for the hours it will take to get cardiac enzymes turned around from the lab. In a trauma situation, doctors and patients can’t afford to wait, but wait they will if we cannot avert this crisis.

Obviously, we need to get more people interested in laboratory science. Most people have never even heard of it, I am constantly having to explain to anyone that asks. The funny thing is, once people know, they are always very interested. I think many people never even stop to consider what happens to their blood after it’s drawn- those that do tend to believe doctors or nurses run the tests or that they are fully automated. Even the internet is tight lipped- a google search finds the ASCP website (which despite being our primary professional organization is remarkably bereft of good, layman level information) and departmental pages from some of the major universities who offer the degree (including mine!).

That is why I have been writing this blog, and telling everyone who will stay still for even a few minutes how important it is we propel our smart, driven, and detail oriented kids towards careers like medical laboratory science. The high school students who end up the lab are invariably HOSA members who want to be nurses and are usually visibly irritated at having to take a detour into the loud, windowless room with all the complicated machines. We need the honors chem kids, the biology nerds, and the math junkies; who will look under the microscope at the blood smear for the first time and be irrevocably changed. Who will see not a mess of indecipherable cells but a passion and a calling.

I challenge everyone who reads this blog post to talk to at least one person they know about MLS. In fact, here’s a video you can show them:

Our healthcare system depends on our efforts now. This effects all of us.

We are needed.

Spare Parts

I talked a little bit last post about my new found understanding of the importance of organ donation.

I want to talk a little bit about some other ways that we can all help out and save lives, while we’re still alive.

units of blood

Each blood donation takes one unit, or pint, of blood along with a small amount in tubes for infectious disease screening and blood group typing.

A healthy adult human has 10-12 pints of blood, which is actually more than you need. You can donate one pint every 6-8 weeks to someone who needs it desperately to survive. It’s easy and nearly painless, so it’s pretty hard to argue against blood donation. There are size requirements- it varies by blood bank but typically they want you to be over 110lbs for a whole blood donation, which I think most of us are. The phlebotomist will perform a physical and check your hemoglobin level with a fingerstick to make sure you have enough blood to spare, then they will draw your blood. The whole process takes about an hour and is highly gratifying.

I actually donated blood today, and the sign on the wall said the most commonly given reason for not giving blood was “I wasn’t asked.” Well, I’m asking you right now- transfusion medicine saves lives but we need your help too. A single motor vehicle accident patient may require 100 units of red cells. Many cancer patients require weekly transfusions of platelets to prevent catastrophic bleeding. The American blood supply is tenuous at best and emergencies such as mass shootings and natural disasters can exhaust it at a moment’s notice. We need everyone to chip in and help!

If you want to give blood, you can look up what blood center covers your area at this handy search from the American Association of Blood Banking. If you live in a rural area you may be covered by a blood bank relatively far away so set the box to 100 miles and then ask your blood center if they do mobile drives (mine does!). If you can’t find a center through this search, your area may be covered by the American Red Cross. If you live outside the US or are having trouble finding a drive near you, ask your doctor or go to the laboratory at the nearest hospital and ask the receptionist who supplies their blood bank.

If you live within 150 miles of Spokane, WA, including North Idaho and Eastern Washington, your blood center is Inland Northwest Blood Center.

In Western Washington including Seattle, Tacoma, and Everett, your blood center is Puget Sound Blood Center.

The entire state of Alaska is covered by the Blood Bank of Alaska, though supplies to Southeast Alaska typically come from Puget Sound Blood Center due to proximity. Blood drives throughout Alaska, including southeast, are usually held by the Blood Bank of Alaska.

The Portland metro area of Oregon and Western Montana are covered by the American Red Cross.

bone marrow diagram

Bone marrow contains the stem cells that differentiate into all the cellular components of your blood.

Now that you know about the importance of blood donation, you might be wondering what else you can do to help. Please consider joining the National Bone Marrow Donor Registry. All you have to do is swab your cheek and you are entered into a database of people willing to donate either bone marrow or peripheral blood stem cells for patients who need them, often suffering from leukemia or immune diseases who will die without your donation. Many patients die waiting for transplants, so while donation of bone marrow does involve a surgical procedure you have a unique opportunity to give of yourself to save a life. About 1 in every 500 people who signs up goes on to donate, though that number is higher for members of certain racial groups- African Americans are especially encouraged to sign up due to a shortage of donors of that ethnicity. Bone marrow donation is treated like organ donation and you have an opportunity to exchange contact info with your recipient and even meet them. The registry pays all fees associated with screening, the procedure, and even travel expenses for donors. There’s really no good reason to not go and sign up right now, is there?

Changes

I said in my last post, now over six months ago, that life comes at you fast. Even then I had no idea just how fast.

This weekend is father’s day. I will not be celebrating, as my father passed away two months ago, just a statistic, the latest victim of a healthcare system that research suggests kills as many as 98,000 Americans annually through medical errors, misdiagnosis, and dosing errors. (1)

He did not have to die. It was my own home, my own people, my great love- medicine- that is responsible. A single laboratory test likely would have saved him, but perhaps we are not so far out of the dark ages of medicine as I thought.

But I am determined and this will not stop me. I spent the three months of his ICU stay travelling back and forth between Alaska and Seattle, a packed bag ready by the door for the call. I stayed in school, sometimes working on homework late into the night then getting up the next morning for an early shift. And when he died I went home, packed our house in a week, scored a 99% on my final exam, and moved back in with my mom in rural Idaho.

I don’t really want to make this post about my dad. Everything else in my life right now is. This post is about me and my journey. I believe now more strongly than ever in the importance of laboratory science and the power we hold to save lives.

I also have come to understand something to which I never applied much thought. Everyone has something to give, and it’s never too late to change the world. I cannot strongly enough encourage anyone who is reading this, if they haven’t already, to please sign up to be an organ donor. Donate Life America can help you with this, or it’s a simple box to check when you sign up for a driver’s license.

Now, on to other things. I have transitioned to being a full time student as there is not currently a position available for me at my new laboratory. This semester I am taking Principles of Hematology and Hemostasis and Microbiology. It was my initial hope through this blog to provide my first hand experiences of life in a clinical laboratory and admittedly, I’m starting a little late. However, it’s never too late to start, so keep an eye here for hopefully at least weekly posts about my adventures in hematology. I am required for my class to write a weekly log of my activities, and I have six backlogged from this semester so I may put them up at some point.

I also now have a twitter account on which I plan to try to share at least daily an interesting thing I have learned in my studies or research. I hope you’ll follow it and stay tuned for fascinating facts.

And of course, I am still baking. My new home has much more sunlight so I am hoping to get better shots.

I hope everyone has a lovely week and if you’re a father, happy father’s day.

(1) Medical Errors Kill Almost 100,000 Americans a Year. BMJ. 1999 December 11; 319 (7224): 1519.

The Science of Saving a Life

Christmas is over, a New Year has begun, and I am busy as hell.

I actually had this whole week off, and I was intending to spend it in the beautiful new library, obsessively preparing for this coming semester, which I have been told is to be brutal. Lee and I spent last week down south celebrating the holidays with my family and a week of quiet library time seemed the ideal way to preface the coming academic onslaught.

It was not to be.

The internet at large will forgive me sparing the gory details, and to those reading this that know me- everyone is going to be ok! But my “quiet” week has been a whirlwind of crowded last-minute flights, doctors, ICUs, surgeries, lots of uncertainty, and more body fluids than I think safe to discuss.

Peritoneal fluid mixed with bile, baby. Oh yeah.

So I’m in Seattle. In a hospital that’s not mine, a strange reversal from confident healthcare professional to exhausted and wide-eyed family member.

This is going somewhere, I swear. On Monday, I start my first real Med Tech class. I certainly didn’t expect to be starting it from a cot in the corner of an ICU room, but life comes at you fast, kids.

People ask me a lot why I chose to study medical laboratory science. It’s something most folks haven’t even heard of, never considered, but nonetheless might save their life someday. In fact, since doctors base something like 80% of their diagnostic and treatment decisions on information from the laboratory, there’s a pretty good chance that the lab will save their life, and yours, at some point.

Pasteur and Koch’s work with microorganisms and the germ theory of disease may have brought medicine into the modern age, but I firmly believe that it is the medical laboratory and the ability it grants to not just detect but quantify hidden properties of the body that will keep us there.

Your blood is like a book written about you, and the lab is the only place that can crack it open and read it. Your blood can tell us if you’re at risk for heart attack. It can tell us if you’re having a heart attack. It can tell us if you have an infection, if you’re anemic, if you have ovarian cancer, if you had a stroke, what your blood sugar has been for the last three months, if you lifted too many weights at the gym yesterday, and so on and so forth. New advances in genetic testing are even allowing us to take a peek inside your DNA for clues about everything from tailored medication dosage to risk of autoimmune disease.

So, it’s important. It’s exciting and fascinating and it matters. I don’t have the patience or the innate compassion to be a nurse. I don’t want to give up my life to become a doctor. But you can bet when you’re sick I’ll be there help, saving your life with science.

Post Script 1:  If you’re interested in learning more about lab science, the American Association of Clinical Chemistry publishes a great peer-reviewed resource called Lab Tests Online which provides detailed information on most laboratory tests as well as a variety of lab-related topics. Of particular interest: Inside the Lab.