Working in a Hospital’s Lab Spares me from the Daily Woes

My work usually involves me just being in a secluded area of the hospital. It’s the Histopath Section, Morgue, Office, or General Lab Complex that I frequent in but some tiny exposures include the Newborn Screening and Molecular Lab (where RT-PCR tests are done). This makes me disconnected with the daily grind other departments in the institution are doing. Having rare instances of direct contact with patients, we just rely on second hand info from the fellow physicians or nurses on the station to verify abnormal lab results. I like Pathology training for these main reasons: less contact with people and how objective the work is.

Outside the studies as part of the training, conflict resolutions involving lab results are part of the daily routine. The common referrals made by our medical technologists include an increase if blood sugar, electrolytes, quality control tests, identifying cells on a blood smear and rarely some parasites found on smears.

Here’s picture of an Enterobius vermicularis egg on a stool smear. I can't take a good shot even if my life depended on it while hovering the camera on top of a microscope. It’s those D-shaped clear spherical shaped objects. It’s usual collection method is using a scotch tape used on your butt first thing in the morning before bowel movement. But seeing it on stool made it a contaminant. It came from a postpartum patient with coinfection of Ascaris and it’s an incidental finding as successive smears didn’t reveal these eggs anymore. You can find out more about these parasites from here.

Some cases being referred are blood sugar levels being too high. The protocol before releasing any abnormal result is investigating the cause and retesting. For the most part, a reliable medical technologist on the team can resolve the issue without phoning the resident on duty. If the error was technical, like wrong patient, wrong method or sampling, wrong timing or collection, and the likes usually don’t get referred. But cases where it requires correlation with the clinical picture by asking about patient’s working diagnosis, that would require the resident on duty to phone up the ward.

Most of the time, if a blood sugar level is way too high for the usual fasting blood sugar levels, I would phone up the ward and ask the working diagnosis is and other pertinent info. I’d get a string of diagnosis like Covid positive confirmed, lung cancer, hypertensive urgency and etc but the info I would dig up on this case is whether the patient Diabetes with uncontrolled sugar, do they require insulin? Have they really fasted for 8 hours prior to collection? What was their IV fluid on the line? What was their capillary blood glucose levels prior? Any anti-hypoglycemic agents or glucocorticoids being given? Anything that could explain the abnormality.

For the most part, the diagnosis of Diabetes Mellitus type II insulin requiring and uncontrolled solves the mystery but some extra diligence has to be thrown like asking further questions. At the end of the day, if you didn’t do your own investigation and you released the wrong values, it’s going to be your license that’s on the line. You need to stand by the results you release because part of the consequences is you facing legal charges if you fucked up.

When you’re in a different field of medicine, patient-physician relationship is a constant requirement to progress in your career. You got to get your name out there in a good light even if you have to force a smile to problematic patients. I don’t have to think about those stuff because the only public relations I have to worry about is being in good terms with cutting specialties. Even without good relations established, there is still job security as the field has too few specialists on the region so it’s not really competitive compared to fields like Internal Medicine and Surgery.

The daily woes I meant were public relations, dealing with problematic patients and colleagues, other members of the health care team, and then indirect problems one has to mind attached to patient care like insurances and social burdens attached to the patient.

Let me tell you how it’s not your problem when the patient can’t afford health care even if they are in a charity ward. This is a third world I live in where people can’t afford a 3cc syringe out of pocket (about a 0.01$ upvote can solve that) because our public health care sucks and private insurances are costly. So it’s not uncommon to have doctors and nurses pass the hat and pitch it for the treatment just to get it over with because empathy.

It’s pretty whacked when you think about how much a shitty small upvote from an account that isn’t invested on the platform can solve the trivial daily problems that happens here. How much more if I told people about this place being a magic printer for their social aid.

You’re not obligated to go out of your way to make people’s lives better given the limited resources you have for yourself. And if you do obligate yourself, it’s to fuel your noble cause and that’s fine. The same is true for an institution that is built around a business model that relies on people getting sick. It’s fucked up to think that part of the mess is providing a lip service that the system cares (they do but it’s usually not enough to cover the demand). So the end point is a compromised patient care that can’t be helped all because of limited resources, poor resource allocation, and politics (you can’t remove that to the equation).

I witnessed a patient dead on arrival but the folks refused to have the body be admitted and examined. They would have to have the body be swabbed and if positive for RT-PCR covid, cremated as per protocol. Other than additional health care costs going to a cadaver, they also outright refused cremation. So in the end, they opted to nope out and left. All that happening while I was waiting for my monthly surveillance swab test and it just got me thinking this being a normal thing I just don’t see as I’m working in a secluded place.

When reading and making a report about a patient’s peripheral blood smear exam, I would occasionally follow up on the patient on the ward asking for the working diagnosis and whether they received a blood transfusion only to be told they expired. I must have felt something when I started training when these occasions happened but now I can brush off those silly ideas and just look at the slide as just another slide to read and make a report to. I don’t have to deal with the emotional burden of watching how the deceased passed in the wards.

No need to trouble myself explaining the limitations of a Do Not Resuscitate form to grieving folks if they opt for one. Instead I just receive some samples, or a corpse to autopsy and that’s it. There’s plenty of crazy the world already has going and I can only focus on the small stuff I can mind.

If you made it this far reading, thank you for your time.

Posted with STEMGeeks