Buried

Wow, it has been awhile since I have blogged. I have been buried by work on my current rotation. It has been interesting and I have learned a lot. But I will be glad to see the 2 months come to an end and to get to move on to something else. There is a lot going on in the world of health care right now--swine flu, Obama's plan for reform, and an IOM report uring MDs to stop taking gifts from drug companies, just to name a few. Perhaps I can discuss some of those issues later.

But I bet that you did not know that last week was National Medical Laboratory Professionals Week. This years theme was "Laboratory Professionals Get Results." Cute. I would not have known about lab week either except that I was surrounded by the festivities. For me that meant grabbing some cheese, fruit, and ice cream from the many free lunches that occurred and running back to work.

In a way it is kind of sad that no one outside of the lab really knew about lab week (except, of course, for the staff from a neighboring department who crashed every event to take free food). Over the course of this year I have come to realize that few people really know what goes on in a clinical laboratory most of the time. I am included in this too despite having done a rotation in "lab management." To sum it up very briefly it takes a lot of staff, coordination, and regulation to keep all of the machines and tests putting out high quality data. The laboratory professionals are highly skilled and there is a huge shortage of them nationwide. Better publicizing lab week might be a good way to call attention to the shortage, to help everyone in health care better understand what it is exactly that laboratory professionals do, and how essential they are to providing good patient care.

The Bathroom Files

Who knew that the bathroom could be such fodder for blogging?

When we last left off, the Lone Coyote was celebrating the fact that she had finally conquered bureaucracy and gained access to the vaunted staff bathroom. Trust me, celebration was warranted given the other options for restroom access in the vicinity. But after about a week of staff bathroom access, I have concluded that strange things can occur in hospital bathrooms. And apparently I am not alone in my observations. Three colleagues and I spend a good 20 minutes yesterday sharing bathroom stories, laughing, and feeling generally grossed out. Here are a few of the highlights:

The Hiders: the staff bathroom clearly serves as a hideout for employees who do not want to do their work. Several times already I, or another one of my colleagues, have entered the bathroom to find all of the stalls full. The feet can be seen underneath. We wait. And wait. And wait. No movement occurs. No sounds are emitted from the stalls. Even exiting and returning a few minutes later does not seem to change anything. They are on a long bathroom break.

The Toilet Paper Tsunami: by the end of the day their is always a humongous pile of toilet paper and seat covers on the floor of the stalls. They aren't dirty, just strewn about in a pile. I am not sure what the appeal is of throwing paper all over the floor, but clearly someone has a fun time.

The Beauty Salon: I also noticed that there were often large puddles of water all over the counter and the floor near the sinks. We are talking lakes here, not little splashes. According to one of my colleagues, she had wondered about the origin of the daily puddles too until one day when she walked in and found a couple of staff members washing their hair and generally "washing up" at the sinks. You'd never know there is a staff locker room with showers that can be opened with the same key card right across the hall.

All of this in just one week. And I'm sure there will be more to come.

When You Gotta Go, You Gotta Go

On my current 2 month rotation, I was rather distressed to find that bathroom access was a challenge. Near the lab is a "Staff Restroom" with card key access. Of course, my card did not open the door. I would have to stand in the hallway and wait for someone to walk by, take pity, and open the door. More often than not, I would have people pass by and look at me like, "why can't you open the bathroom, there must be something wrong with you," and dart away. Ironically, my attending cannot even get into the bathroom and was once berated by a staff member about not being able to open the bathroom door.

I decided this had to be dealt with and found out from another resident that the security office could fix all of my problems. Thus, I embarked on journey to the basement where I was told to "send an email." See below for the rest.




-----Original Message-----
From: The Lone Coyote
Sent: 4 Days Ago
To: Security
Cc: Another Resident
Subject: Access to restroom/locker room

To Whom It May Concern:



Who needs access? The Lone Coyote, MD and Another Resident, MD

Where? Women's Staff Restroom/Locker Room

Why? So that we can have a bathroom to use.



Our Supervisor: Program Director, MD.



Thank you for your attention to this matter.



The Lone Coyote



The Lone Coyote MD
Resident
----------------------------------------
From: Security
Sent: 4 Days Ago
To: Some Supervisor Deep in Bureaucracy
Subject: FW: Access to restroom/locker room



Is she ok for womens locker room access?
------------------------------------------
-----Original Message-----
From: Some Supervisor Deep in Bureaucracy
Sent: 2 Day Ago
To: Security
Cc:
Subject: RE: Access to restroom/locker room

Sure, this is fine.

Thanks,

Supervisor
------------------------
From: Security
Sent: Late This Afternoon
To: The Lone Coyote, MD
Subject: FW: Access to restroom/locker room

Done.


Woohoo!!! We can go pee in style now.

More Elevator Adventures

Overheard in the elevator... not the same one I wrote about the other day.

Nursing student: (pushing button)
Nurse: No! Not that one. This one. (points to another floor)
Nursing student: I'm sorry.
Nurse: You can't even go to that floor. (points to button student originally tried to press)
Nursing student: Why not?
Nurse: You need a special key to get off there. The babies are there. The babies have to be kept safe.
Nursing student: (nodding) Yes, that is very important.
Nurse: (snorts and rolls eyes at student) I really don't see what the big deal is. I mean that is the ICN. That's where all the super-sick babies are. They're in bad shape. Many won't make it, and if they do, what's the point.
Nursing student: (looking stunned)
Nurse: I've always thought if you want to steal a baby, those babies are not good specimens. You should try the Well Baby Nursery. Those are worth it.

And with that they reached their floor, which houses adult patients, and got off.

Elevator Adventures

We were coming back from a bone marrow biopsy today when our elevator was "captured for hospital emergency." Wow, "elevator capturing" sounds like it could be some new extreme sport or an event at a rodeo. But it's really not that exciting. Basically, it means that the elevator is needed to transport a critically ill patient, usually from the ED to the ICU, and someone with a "code key" uses his key to call the elevator directly to a specific floor.

We exited the elevator at the ground floor to let 2 nurses push a patient and numerous beeping machines into the elevator. Then we waited. And waited. And waited for another elevator to come. Soon there was a whole cast of characters waiting with us. Nurses, respiratory therapists, physical therapists, clerks. Everyone was chatting it up and expressing annoyance at the slow elevators. Finally, an elevator arrived and all fourteen or so of us piled in. I was in the way back of the elevator smushed in next to the lab tech with the bone marrow tray. Let's just say it was a very tight fit.

We go all of one floor up and the door opens to reveal a food service worker waiting with a huge steel cart full of patient lunch trays. There was no way in hell that this food cart could fit into the ~2 square feet of open space left in the elevator. But she was going to try. She started pushing that steel disaster towards the elevator and a man by the door said, "no way, not going to fit." The lady got angry and shouted, "this is for patients, I need the elevator, get out!"

Everyone was stunned and then a very quick thinking person in scrubs yelled back "We are all patient care in this elevator!" Several people started to laugh and one nurse yelled "goodbye" and pushed the door close button. The doors slammed, just missing the cart that she was still trying to wedge in to block the door, and we were off on our slow climb to the top of the hospital.

Diagnosing Bad News

I am feeling much better. Thanks for all of the comments. It's nice to see that people are still stopping by.

These days I am on a very busy hemepath service where I spend my days looking for leukemic blasts and the other abnormal cells that signal cancer of the blood and bone marrow. Inevitably, we get a horrible case at the end of a long day. It's hard to describe the sinking feeling I get in my stomach when I focus the scope and see blasts everywhere. Their monotony signals badness. Often the clinical team has arrived to see the case and everyone sits silently taking it in.

We apologize. We look around, hoping to see something that might change the diagnosis. But the badness is still there. For that brief moment before they have to run back to the floor we all share a collective sense of grief.