A Hospital Lab that Never Sleeps
By Julia Sklar
BU News Service
Almost everything here is a variation on a bland theme: eggshell laminate countertops, off-white and cumulonimbus grey machinery, dirt-speckled snow ceiling tiles, and beige linoleum. The room is altogether too small to hold its contents, like the growing child of a thrifty parent, squeezed once more into last year’s overalls. Nothing about this place is glamorous. But for this clinical chemistry lab on the West Campus of Boston’s Beth Israel Deaconess Medical Center, it isn’t about glam at all, it’s about precision — “GET IT RIGHT THE FIRST TIME,” reads an authoritative sign on the wall. “Patients are relying on you,” it implies.
Despite that few patients actually know the lab exists, the medical technologists who work here are an integral part of the team keeping tabs on their wellbeing, whether patients are hemorrhaging on an operating table or at home waiting to find out about their thyroid-stimulating hormone levels. In the course of a year, the medical technologists will run 1.7 million tests on samples of blood and urine; in a single day that boils down to 4,850 tests on 1,000 samples. But with increasing pressure from automated technology that can run many of these tests on its own, this lab is a fast-paced environment at risk of extinction.
I first visited the lab on a Friday afternoon, but T.G.I.F. means nothing here. The room thrums with mechanized importance 24 hours a day, every day of the week, and stays constantly connected to a plexus of pneumatic tubes that delivers samples from most patient floors, operating rooms, and the emergency room. This lab is the proverbial heart of the hospital, and its pace fluctuates with the rise and fall of hospital activity taking place outside its walls.
If prematurely born triplets are struggling to breathe in the neonatal intensive care unit, checking markers of fetal lung maturity always trumps something routine like a glucose tolerance test. Moments like these shift the energy in the lab: Medical technologists begin to analyze urgent samples with a sense of controlled intensity, speaking briskly but clearly to each other, as equally energized machines communicate vigorously in their own way — through the cacophonous clicks and whirs of their moving inner parts that carry out the actual tests. On the side of one of these machines is a print out of a jubilant Bob Marley with a speech bubble that reads, “We be jammin.’” He’s not wrong; this room sounds like a medical symphony.
But it didn’t always. Yeas ago, the lab was far less mechanized and much quieter.
My mother, Carol Sklar, joined this inner sanctum of hospital life in 1974, when the lab’s walls were adorned with “cool plaid wallpaper that was hot pink, green, and yellow.” The lab only housed two seemingly out-of-place testing machines, tucked away in a back corner. Most assays — measurements of the biochemical and immunological makeup of patient samples — were done by hand. Some of the tasks she and her colleagues completed even required “mouth pipetting,” using their mouths as suction devices to move patient samples.
“Sometimes you’d overshoot, and get a sample of urine or something in your mouth, and you’d have to spit it out,” my mom reminisces, “People were always spitting in the sink.” Accidentally sucking up trichloroacedic acid — a substance used to analyze protein levels — was particularly sensorial. “If you got that in your mouth, it felt like your mouth was hairy,” she says.
Adele Pistorino, the lab’s current supervisor, joined the team in the early 1980s when mouth pipetting had just gone out of style, but medical technologists still used few safety measures when handling samples.
“When I first started, someone in the lab got hepatitis every year,” she says. “Now we try to treat every patient as if they have hepatitis or HIV/AIDS.”
In today’s lab, however, precautions abound. The biohazard symbol is more ubiquitous than employees — it’s plastered on every incoming patient sample, many of the machines, and several designated waste containers. And everyone wears latex free gloves and gauzy yellow gowns that tie in the back.
But this vibrant world is shrinking. The schedule for the week of November 10, 2014 shows 14 people working on weekdays, and seven people working on the weekend, compared to 60 and 17 when Pistorino got her start.
“That’s been the biggest change over time, and it just slowly evolved,” she says. “As people left, we just didn’t rehire. With the instrumentation, we need fewer and fewer people.”
It’s a trend that’s likely to continue. For nanotechnology researchers, developing a “lab on a chip” is a high priority; such a device would theoretically condense this entire clinical chemistry lab, and others like it, onto a minuscule piece of plastic. In a lab on a chip, tiny amounts of blood or urine pass through small channels to undergo a host of chemical and physical tests, producing results in a matter of minutes, rather than hours or days. Right now, its portability and rapidity show particular promise for military personnel — who often lack access to the full resources of a hospital lab, and who are constantly on the move — but the aim is to bring this technology to the general public. Pistorino remains confident that her lab will never be obsolete, though.
“There’s only so much that a computer can do,” she says. “They also make mistakes, and you really need a person behind the process.”
For her and her colleagues, analyzing samples really is personal.
“You always think that it could be your mother, or your brother, or your friend who you’re running tests on. I think you really have to work like that,” says Pistorino. “You want to make sure that you’re sending back the right answer in the most timely manner because people, like a surgeon in an operating room, are making decisions based on what your tests are resulting.”
So for now, the lab stays. When I returned early on Monday morning, automated pipettes already busily vibrated and dipped dispensers in and out of tubes, like the beaks of thirsty humming birds dipping into nectar. Phones rung roughly once per minute, with nurses on the other end, relaying patient information as it happened. Six signs taped to the walls read, “MASSIVE HEMORRHAGE — 11/9/14, 9:15 PM,” vestiges of a night shift emergency that by the day shift had been reduced to mere pieces of paper, flapping around in the air vents’ chilly currents. New patients with new problems were already entering the hospital. Today, medical technologists will run another 4,850 tests on 1,000 samples, like they did yesterday, and the day before, and like they will again tomorrow. All with a meticulousness that comes from knowing that the patient on the other end could easily be their mother, or their brother, or their friend.