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One of our biggest clients is the local psychiatric hospital because a good chunk of the facility is rehabilitation and addiction management. Lately, there’s been a population of patients who were coming up positive on the amphetamine drug screen but we have never been able to find anything that could explain it in the confirmations. This is not the most bizarre thing because amphetamines are very volatile so if you have a tiny concentration in the urine, you might lose it in the extraction (which contains dry down steps).
However! One day we got a box full of homemade cigarettes from the hospital which were taken from an “entrepreneur” who was selling them to patients and we were asked to do extractions on them to see if maybe we could find this mystery amphetamine or cross-reactant. (Unrelatedly, I thought the surgeon general’s warning sticker is a really charming touch)
We tried a number of extraction methods but never did find the amphet. In fact what surprised me was the fact that, compared to commercial cigarettes, these were actually really clean!
So I have an interesting case of environmental toxicology.
One of the local hospital’s neonatal ICUs has been suffering from an outbreak of bloody diarrhea. Obviously the first thing they suspected was some sort of infection, so they recruited an epidemiologist to puzzle it out, but they quickly ruled out both bacterial and viral infections.
We got a bunch of water samples from them for trace elements analysis and it came back negative. But we also got some baby bottles from them and they had really high zinc levels, so they suspected something is leaching from the bottles.
We then got a bunch of urine samples from the babies and indeed the zinc levels are through the roof.
We asked the clinical toxicologist if this could be related and indeed, high zinc levels can be a cause of bloody diarrhea. Imagine that.
Long time no see, Tumblr! I have been busy with personal things and I apologize.
The first of our month of Instrument Shenanigans, the Tigris, our gen-probe analyzer, is a qualitative nucleic acid test based on transcription-mediated amplification which we use for gonorrhea and chlamydia testing in chemistry. At some point in our run, the instrument got contaminated and about 40 patients all tested positive for chlamydia in a batch run. Chlamydia is pictured above in the vacuoles of a cell off a pap smear (we were actually running urines).
Luckily, the tech on the bench was astute enough to notice this before results were filed, so it was all resolved in the end.
Sometimes I think back and contemplate all the surreal collecting moments in my training and laugh awkwardly to myself in reflection.
One time, I was on the transplant ward for morning rounds and I went into this room with a lady who just had a lung transplant (among other things). She had IVs running in both arms and as I was remarking on the IVs, she told me to collect from her foot.
This was innocent enough until I lifted the blanket and found she was a below the knee amputee on both legs, ie, she had no feet from which I could collect. I was a bit thrown but explained that I… couldn’t… collect from there. She continued to insist because all the other lab staff could do it, so there was no reason I couldn’t.
(I eventually convinced her to let me turn off the iv for a bit to collect from her arm. But very surreal all the same.)
Brucella sp (tiny Gram negative coccobacilli) gram stain.
As part of our proficiency testing, accrediting bodies send us mystery samples to identify. In paper, they tell us they’re typical specimens, but in practice, they are always incredibly difficult to work through!
This one time, we were super stumped on this one organism. Everyone was smelling the plates (as an aside, “smell” the plates but don’t smell them, that’s dangerous) and throwing test after test at it. We had all of our microbiologists and a good chunk of the staff standing around huming and hawing over this and sniffing it for about a week.
We eventually realized it was Brucella abortus which should have been sent to the Level 3 lab and safely sealed away from day one when that indole didn’t go positive… any of the 6 times we did it.
Only one person got sick with it which is pretty impressive but still terrible.
Let me tell you about my most interesting bone marrow collection.
Here, the way they are done is a pathologist does the collection and the technologist assists them by setting up his tray, injecting the syringes full of aspirate into the correct tubes before they clot (some pathologists like to throw them at you; that is gross), and making smears, etc.
The patient was a sternal collection. It was also rock solid there and the pathologist had to climb on top of her and was all but drilling the needle into her chest. Even when it is soft, this is a horrible thing to witness when you are a patient and that is partially why we normally collect from the posterior. We also couldn’t get a trephine out at the end because the marrow itself was so soft, so we ended up tapping two more holes.
The first EDTA also partially clotted and we needed another aspirate which was so hard to pull, it clotted before they could even unload the syringe and we decided to make do with what we could because it would only get harder from there.
In the meanwhile, the patient had a reaction to the anesthesia and vomited.
Trichomonas vaginalis, the causative agent of trichomoniasis, which is more common than you might expect!
In our micro department, when you work nights, your whole shift is basically looking at genital smears. This is not a very exciting shift so a very bored someone (not me) took a wet mount positive slide and put iodine at one end of the coverslip. She then watched the advancing iodine front as it made all the jiggling trich seize up and die what looked like a painful death on contact.
A long time ago, I did some collections training at a hospital that pretty much had 3 populations: complicated pregnancies + very sick babies, drug abusers, and a small group of “everyone else”.
Drug users often have a huge stinking vein in their arm but we pretty much never get to use it because it is their drug vein and they don’t like people touching it. 9 times out of 10, their other veins are incredibly wispy or incredibly scarred, both of which are terrible things to collect from and we normally try to avoid if possible.
This one time, there was a known drug user that my trainer and I couldn’t successfully collect from, and it was going to become a Doctor to Draw order, ie, no one is allowed to touch him for 24 hours unless it is a doctor because they are allowed to draw from some pretty strange places if they really want the blood. So the patient said to us, “listen, I promise I won’t stab you, but if you give me the needle, I can do the collection for you.”
We ended up letting him and he got the tubes from one tiny little vein on the back of his arm. Which is not a usual poke site at all.
It was interesting.
An H&E section of a complete hydatiform mole, an abnormal pregnancy where a non-viable, fertilized egg implants in the uterus.
Semi related story time! I have a problem with people not screwing the lids on things before sending them to us. Pee that smells like raw fish that’s been left in the sun for a few days and leaking all over things is one thing (and apparently a daily thing). But when I pull out a bio bag where the bloody specimen is no longer in its leak-proof container because someone didn’t screw the lid on right (such as today), that is a problem.
And when the contents happen to be Products of Conception, AKA someone’s spontaneous abortion, AKA something we can never recollect, that is unacceptable.
Meet the DxC, we have two named Dixie and Dexter. I’m about to tell you a very convoluted story involving Dexter.
So for the last couple of months, both of them had been kind of acting up, Dixie moreso even though she’s the lead instrument, so Dexter has been doing the bulk of the work. That day, the maintenance guy came to fix them both up, and he was working on Dixie first.
Throughout the day, Dexter had been spitting out random samples without running them because he would error in the middle of a sample and no one knew that he had skipped them (they went through the probes and scanners and everything). 3 hours into my shift, the nurse calls asking for a STAT result sent in at like 6AM (we get 1 hour to do a stat test, it was now 10AM) so one of the chemistry techs starts looking for the sample. She recruits a couple of lab assistants and they’re ripping the lab apart looking for this sample.
11AM is when a whole batch of new collections come in. Dexter is already overworked. He is still erroring. The missing STAT is still missing and we think it wasn’t received.
Then the man who needs to change the water tanks for both instruments arrives suddenly. And he says it will take about 10 minutes tops. Dexter completely crashes at this point and now we have no chemistry analyzers online. And we’re like, okay, let’s just change the tank and get it out of the way since they’re already down.
The DxCs have a reserve tank that can run about 10 tests in emergencies and the reserve is used up trying to recover Dexter from the crash and Dixie is lying in pieces on the counter. The phone is now ringing because the nurses want to know where their test results are.
The water change goes poorly and the lab is suddenly starting to flood. I crawl behind the instruments and hold up all the electrical lines so nothing short circuits while getting slowly soaked with fancy water as the water guy tries to stop the spray.
The stat is still finally found. The new samples are piling up, and now we have to rerun a bunch of the morning’s work because they were never tested at all.
Welcome to the lab?