While that’s happening, STAT specimens are coming in from the emergency room. Some are pregnant women who are bleeding, and they need their blood type to see if they need a shot of Rh immune globulin. Some are GI bleeders. Some of them are cancer patients whose blood is delpeted after chemo and they need a transfusion because they’re weak and having trouble breathing. I’m doing my best to prioritize as they’re coming in one after the other. Things marked “routine” are sitting in the rack, waiting until I have time to get to them. I’m also in charge of all the rapid testing for influenza, mono, strep, and RSV, and we’re in full blown flu season so those swabs are starting to pile up. While my latest type & screen is incubating, I start a batch of 3 flu and 2 RSV, and then a few minutes later they bring me a new handful of swabs so I set up 2 streps and another flu – now I have several timers set for different tests, so things are beeping everywhere. I hate beeping.
So, while I’m calling a positive flu result to the pediatrician in the ER, someone shows up to get plasma on a patient. I don’t see any thawed, so I look up the patient in the computer – no, nobody called to say they wanted a unit of plasma, so I need to call the floor and tell them it’ll be a half hour while it thaws. I pull a unit out of the freezer to thaw, and oh, now my timer’s going off for my type and screen, so I need to move that to the centrifuge. Oops, forgot to put that flu result in the computer. And looks like those strep tests are done too, better result those. And there are two papers in the fax machine asking me to add on more units to a couple of patients.
Phone’s ringing, now a patient in critical care is crashing and they want 2 units NOW and then 8 for the OR because they’re wheeling her down the hall to surgery almost as we speak. Yessir! I’m on it! Once I find the specimen in the fridge, I see there’s not much left, those tubes must have been only a quarter full when we got them yesterday. I can crossmatch 6 units, tops, before I run out of specimen, and that will leave them stuck with needing to get a new specimen in the middle of surgery. I tell the nurse I’ll give her those 2 units now, and she should get a new specimen right afterwards so I can get ready for the OR. She agrees and hangs up. So I go back to working on another ER Stat and those two add-ons, and they call back to say the Dr does not under any circumstances want her redrawn now. Get as many as I can ready and he’ll make do. I don’t like this idea, but there’s not much I can do other than document that this was his call and he’s aware of the situation. So I get those ready while I get back on the phone to call Labor and Delivery with a result on a baby’s cord blood. I have to talk fast because the printer paper that my unit tags are printing on is about to flip over and get crunched up and jam, so I need to get over there to rescue it. Oh, and the plasma’s done thawing and the thawer alarm is screeching at me to tell me so.
Now the OR calls. The anaesthesiologist wants to know how much blood we have ready for a patient. Well, we don’t have any because we don’t have a specimen on him. The doctor’s confused, because the patient is wearing a blood bank armband, so how do we not have a specimen? Well, it turns out that when I called the emergency room yesterday to tell them their specimen was too hemolyzed for me to use, nobody bothered to cut off the armband. So when he went upstairs, they assumed he had a valid specimen. So here he is about to get cut open and because he’s got an armband on, they figured everything was ok! It happens, it’s not the end of the world, I told him to get me a new specimen and we could have stuff ready for him within 45 minutes. But he was upset (rightly so) and was asking all sorts of questions about how this could happen. All I could do was apologize and tell him we can do it in 45 mins. Over and over again.
And the pediatrician is calling, asking for RSV results on a sick kid. A test I haven’t had time to set up yet. Sigh. More apologies, promises to get right on it. I feel terrible, because I know that if they’re calling it’s because there’s a very sick kid out there waiting for the right diagnosis and treatment. Then the OR calls about that first patient, asking if I have the 8 units they need… so I have to tell the whole story again and make sure they know I’ll need a new specimen if they go through all six units.
And I really, really have to pee.
So, this wasn’t just a post to vent about how hard I work or how stressed I am – plenty of my coworkers work just as hard, and not every day is like this. I’m just trying to give a picture of a busy day and open this blog up to questions from the audience about what I do. The hospital lab and blood bank are mysterious hidden places, and most people have no clue what goes on there, or why. so if anyone has anything they want to ask about the lab, the blood bank, or about blood or medical testing in general, please ask in the comments, and I’ll take the time in future posts to address them all.