The month was August, the year was 2021, and I was locked inside of a patient's upstairs apartment in the midst of a sweltering New England heatwave.
My patient: a 55-year-old febrile man, homebound, Spanish speaking. I had just extracted three tubes of blood from his right antecubital fossa and had a list of ten other patients to see before delivering his blood to the hospital for specimen processing. Now, I was crouched below his doorknob with a bobby pin in hand trying to channel my inner John Wick to escape the wrath of locked doors – and what I suspected to be a COVID-19 infection.
The patient was sitting at his kitchen table, apologizing profusely, as I tried to reconcile all of the ways this strange situation could have been worse. Finally, I heard the unmistakable click of the lock, gave the patient my pleasantries, and headed on out to bring his precious tubes of blood to the mini-centrifuge that had a permanent home in the trunk of my car.
As I finished up drawing blood from the remaining patients on my roster and headed back to the hospital, all I could think about was the events of the preceding morning. I had acquired a useful set of skills by working as a home-draw phlebotomist during the COVID-19 pandemic, with tactfulness climbing its way to the top of the list.
From specimen to analyzer
Although I had worked as a phlebotomist for several years during my undergraduate years and beyond, I decided I wanted to be involved in what happened with bodily fluids after they had, well, exited the body. This realization led me to years of involvement in pathology and laboratory science, and to a job where I had the opportunity to explore the inner workings of the hospital from the standpoint of the laboratory – where science and clinical skills come together.
I stumbled upon a job as a clinical laboratory assistant right around the time of the locked-in incident, and continued to work as a phlebotomist concurrently. This allowed me to see the entire journey of the specimen from patient to analyzer to lab results.
Eventually, I decided to dedicate my time to the clinical lab fully. Here, I worked in both clinical chemistry and hematology – two areas of the lab that helped me establish a firm foundation of clinical pathology before truly learning the pathophysiology of disease during medical school.
Discovering the microscopic world
To me, everything about the laboratory was novel and exciting… even years later. The way that instruments are treated like patients, with constant assessing of quality assurance and tending to hiccups, the rapidly changing advancements in technology, and of course, looking at peripheral blood smears under a microscope.
I remember spending quiet weekend afternoons with co-workers, identifying cell types for fun and looking at canonized cases of blood parasites and sickle cell anemia under the double-headed microscope. This was contrasted with the busy Friday nights, when we would receive hundreds of specimens from everywhere in the hospital and outpatient labs, triaging specimens in the same way that we would triage patients.
The medical laboratory scientists and technologists I worked amongst were incredibly well versed in lab values and pattern recognition, and their diligence and attention to detail inspire me to this day. As they introduced me to the microscopic world that exists within all of us, I became more affirmed that pathology and laboratory medicine was the perfect fit for me – a feeling that remained with me throughout medical school.
Back to the classroom
When I started medical school, I was fortunate enough to keep my job per-diem at the lab, and would work over holidays and long weekends. My experiences in the lab helped me with my studies in a practical and basic sense: knowing reference ranges, the components of a complete metabolic panel, and how to interpret a complete blood count on a rudimentary level. But, more than that, my experiences helped me understand the ways the laboratory elevates the hospital from the medieval days of medicine, when all a physician had was the physical examination to make an entire diagnosis and treatment plan.
Choosing laboratory medicine
It happens every time I’m asked the inevitable question by peers, physicians, family, and friends: “What field do you want to go into?” I tell them “pathology” and await the responses – ranging from inquisitiveness, through confusion, to thinly veiled revulsion.
Reactions of positivity and support tend to come from those who have had experience with the laboratory themselves. That says to me that we need to work together to unravel the mysteries that lie behind the doors of the laboratory for those that are in medical school and beyond. We need clinicians and students, alike, to appreciate the work behind the laboratory data and pathology reports that populate patients’ charts across the country.
With technological intelligence slowly but surely being integrated into clinical informatics, pathology will likely change along with the rest of medicine. As physicians, we should be versed and interested in where the data and information that will be driving our clinical decisions comes from. Maybe these changes will cause the paradigm to shift, and we’ll see people of varied backgrounds seeking out the laboratory – with intention and enthusiasm.
Samantha Scetta is a fourth-year osteopathic medical student at The University Of New England.
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