Thursday, November 20, 2008

Shady company.

If you've ever seen my blog before you know that I'm always preaching about doing what's right for the patient above all else. Forget the fact that you feel slighted by someone calling you and bitching, forget about extra work it may cause you. Above all else, our responsibility is to the patient. With this said, I now understand a little better why many of the older techs at our hospital are good with washing their hands of any problem and not worrying about it so long as they won't be held responsible.

I was working a night in the blood bank. I think I've stated before that we're a reference lab for many smaller hospitals in the area. On the shift previous to mine, one of the smaller local hospitals sent a sample for a red cell antibody ID. The patient had a FYa antibody. This particular antigen on red cells occurs in about 66% of the normal population so there is about a 33% chance that a randomly selected unit of blood will be compatible with this person. They sent us sample of two units in their inventory to do testing. They needed two unit crossmatched. At a 33% likely hood of compatibility, it's not too likely both of them would be negative.

The tech on the shift before me basically washed his hands of the problem by informing the smaller hospital that they had to call the blood donor center they use and have them do the work since we didn't have everything we needed to help them out. About an hour later I get a phone call from the local blood center, of course it's midnight on a friday night, I'm informed that unless it's a medical emergency they're not coming in. That's fine, It really doesn't effect me. Except, The hospital says We need it tonight, but it's not a medical emergency, I don't get it.

What I find out, is that this gentleman's only diagnosis is anemia and they want to discharge this patient. The Dr. seems to be looking out for his best interest, in terms of cost for the patient, and in hoping to get him out of the hospital to prevent things like nosocomial infections. I can appreciate that. So I agree to have the blood center send me some historically FYa antigen negative units. I'll do the antigen typing and the extended crossmatch and go ahead and send these units on to the smaller hospital. It's alot of extra work, but it should do two things, It should save the hospital money considering this hospital is a satellite hospital and under the same blanket organization. The second thing it should do is enable the patient to receive the units he needs more quickly.

I complete my end of the bargain and send the units on their way. and try to leave an email to the blood bank supervisor about what happened, hoping all the charges can be fixed appropriately. Come to find out, the blood center charged us for the units, then charged us a "consulting fee" of $800 even though the on call tech from the blood center called me. Somehow, they even passed on charges for the work I did, to the satellite hospital.

Basically trying to do the right thing financially effed us, not to mention it caused me a shit ton more work. I easily could have washed my hands of the situation and said that it's a contractual problem between the blood center and the smaller hospital, but nooooo I had to try to do the right thing for the patient.

Frankly, I hope events like these won't cause me to think twice about doing the right thing for the patient. I can see why people are so hesitant to go out of their way to help, in the long run you're just screwing yourself. I hate being a hypocrite more than anything in the world

Sunday, November 16, 2008

Rumblings and grumblings

I haven't really had anything blog-worthy happen lately so I have a list of a few things I just want to get off my chest.

1. I really, really hate having to call positive blood cultures to Docs at 3 AM. Really, I don't like to call anytime but 3 am just sucks.

This happened awhile ago but I just remembered it while I was typing how much I hate calling blood cultures We have a set of Dr.'s at my hospital that are married, one is a surgeon the other is a hospitalist, I think. I had just started at the hospital and was working a second shift in micro. I didn't know that these two doctors were married, and I didn't even realize there were two of them; they had pretty unique Indian names. I had to call a positive blood culture at about five in the evening, so I called the operator and had DR. unique name paged (still not knowing there were multiple Docs.)I get a phone call back shortly and immediately the female doc starts reaming for calling her on a Saturday during her time off for a patient that wasn't even hers. How could I possibly make such an egregious error? I swear to you I spent 10 minutes listening to her bitch. Finally, at the end of it she said you probably want to talk to my husband, here. Her husband took the phone and was surprisingly nice. I was on the phone for about 15 seconds and we were done. How hard would it have been just to hand the fucking phone to your husband in the first place?

2. To my wife; if you're too sick to clean up after our son while I'm sleeping, then you're too sick to play on Facebook. Grow up. I fuck HATE Facebook! If I could ground my wife from it I would. I can't count how many times I've woken up and there she is sitting on the couch while my son has a full diaper and crap all over him and the house is a mess while she's on the computer chatting on Facebook. Facebook, I hope you die!

3. To my boss; Do you're own damned job. Before I took the job I'm in now, I took an entry level position and amounted to me wasting my degree but it was a foot in the door after some hard times. Anyway, because I know this job, I get screwed any time our specimen processer decides not to show up. Recently, we hired a new girl and she can't seem to make it to work. Because of the fact it's impossible to fill that job, she may have to kill someone to get fired. Anyway, my boss grew a pair and put her on probation and gave her a list of things she needed to improve upon if she wanted to keep her job. My boss approached me and said I really needed to take time and try to help the new girl. I needed to not only do my job, but retrain someone else at the same time. Ummmm, no. Do your fucking job and make sure people are trained correctly. I refuse to make my life harder simply to make yours easier. I'm the shortest tenured person on my shift but somehow I'm already the go-to-guy. I don't think I'm alright with that.

I saw a couple of funny quotes posted lately and I wish I could give credit but I don't remember where I read them.
1. "You can't cure crazy or stupid".... so true
2. A positive attitude may not solve all of your problems, but it will annoy enough people to make it worthwhile".

Saturday, November 1, 2008

Powerpoint Fun!

There's a good chance I could be fired on monday.

Last night I called a floor and informed the unit secretary that a protime on a patient was clotted and would need to be redrawn.

Five minutes later a nurse calls me and asks what I did to the specimin and informs me that it was a good draw and looked fine to her. I told her that there was nothing I could have done to MAKE it clot. She replied that she wished the lab would just own up to their mistakes and maybe she wouldn't hate us so much and hung up.

I brushed it off, hey everyone deals with stress and needs a release. She was probably busy and didn't want to deal with the nuisance.

Five more minutes passed and I got a phone call from the nursing supervisor asking if I had "dropped the specimin". I said I hadn't and privately wondered why the hell she asked me that. The nursing supervisor hung up and called back about two minutes later to inform me that we needed to run the protime on the specimen we had and that she'd be writing up a QI report detailing how I refused to accept a good specimin. She went on to say that the nurse is postive it was a good stick and the problem must have happened in the lab.

I knew full well that there's not point in doing a clotting study on a sample that's already clotted, evidently I couldn't explain this to her. Sometimes I wonder if nurses always know what tests are for, or if they simply know if something is out of range, and what needs to be done i.e. call the doc. Either way, eventually I convinced her I wasn't going to run the sample and she had to have it recollected.

Most normal people would let this slide. I knew I hadn't done anything wrong but frankly, if my time is going to be wasted on filling out/sitting through a reading of a QI report, I was going to waste her time.

I decided to spend the rest of my free time that evening creating a power point illustrating how the coagulation cascasde works and how sodium citrate works in binding calcium to prevent the cascade from ever starting. Thereby illustrating how if a sample is collected correctly, nothing I can do, short of adding more calcium would make it clot. This included the dropping scenario. No matter how many times a specimin may be dropped it won't spontaneoulsly clot.

I can't figure out how to post a powerpoint on here but if I ever figure it out I'll try to. I haven't gotten a response to this yet. I'm waiting, probably untill monday but hopefully it's not too bad. Surely my bosses know I'm a smart ass by now.

I'd like to end this post by telling everyone that we're accused of "not getting it". We just don't seem to understand that patients are critically ill and a nurse can't be bothered to redraw a specimen. My favorite line is that we only ask for redraws when we don't want to run something. Let me tell you, I get it. We're all on the same team here and we should have patient saftey and quality of care in the forefront of our mind. There is too much inter-departmental strife that was created because of an "us vs. them" mentality. It also takes me longer to pull one specimin out of my work flow and have it recollected than it would take to just run the sample and send out erroneous results.

I promise I understand that being a nurse isn't easy, I could never/would never do patient care. I also know that nurses are paid much better than we are even though we have similar degrees, ours may actually be tougher in terms of learning bodily processes on a molecular level, and I also know that the squeaky wheel gets oiled. The nurses always seem to be that squeaky wheel. Anyway, I'm tired of being accused of not getting it or just trying to avoid work. Just understand that shit happens. I'm not sitting in the lab making fun of someone for a clotted or hemolyzed sample. Shit happens it's not a reflection on your phlebo skills it's just something that happens, and there's nothing either of us can do to avoid it. I promise I've never had anything recollected out of spite or laziness.

Please pray that I still have a job monday.

Our helpful nurses

This just happened about an hour ago and I don't have any thoughts on it yet so I thought I'd share it with you and let you decide what you think.

We were in the middle of a fire code when a nurse came down to get some blood from transfusion. She comes to the window and says "I don't know if I should pick this up right now, I know he really needs it, but we're not allowed to use the elevators during a fire code and no way in hell I'm walking up 4 flights of stairs.


My Views on gay marriage

Gay marriage is a touchy subject for me. On one hand this is one of the few things I'm somewhat "liberal" about. Our fore fathers set up a system that yes, was to be founded on judeo-christian principles, but above all else was designed to be free. Abraham lincoln was a staunch supporter of the idea that you should be allowed to do anything you want so long as it doesn't hurt the community or another individual. I agree. When did it become the government's place to say who could or could not get married?

I kind of follow in the footsteps of Gov. Jesse Ventura in saying that regardless of whether homosexuality is right or wrong, it's not the government's place to say who can and cannot be wed. It only seems logical that a couple who have devoted themselves to one another be allowed to receive all civil benefits afforded to heterosexual couples.

On the other hand. Homosexuality, in many ways is seen as deviant. Liberals tend to follow Darwin's theory of evolution and prescribe to the notion that only the strong survive in nature. If Humans really did follow this line of thought, then homosexuality could never sustain itself. People would learn that homosexuality prevents reproduction and have no need for it. Although, along the same line of thought, it may prove that homosexuality is not a learned behavior but something coded into a person's DNA. Homosexuality wouldn't exist under darwinism if it were a learned behavior.

What I'm trying to say, is that I really have no idea what is right. Why promote a practice that could potentially be harmful to a community. If homosexuality is a learned behavior and allowed to continue to grow due to new civil freedoms, our ability to reproduce could be hampered, or our available DNA pool limited. I realize I'm looking at a gross view of the subject that may not play out for thousands of years, but I'm just throwing out "what ifs".

Untill someone can convince me otherwise, I agree with Gov. Ventura, once again. I say we should eliminate marriage as a civil union all together. If someone wants to be married and recognized as a couple through church, so be it, let the individual, private churches make those distinctions. We would then simply have civil unions for tax and legal purposes with no hint of the word marriage or definitions for those who can be in a civil union.

Anyone have an argument that might sway me? I'd love to hear people's (non-radical) thoughts on this. I'm a pretty open guy. I just don't know what to think about gay marriage.