blood and baseball

In honor of it being opening week across America I have decided to share my thoughts on how blood donation, or collection rather, is similar to the great American pastime of baseball.

ball

I came to this realization last year and have started approaching each donor as the next game and myself as the pitcher.  Hopefully, even if you know nothing about baseball you are at least aware that there is a pitcher and what his role is and you are able to follow me into this analogy.

The body doesn’t want to give up its blood.  Arms are the batters I am staring down trying to slip the needle past to fill up the 450 ml bag.

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Here are the different scenarios in this game:

Sometimes I have no issues.  Good needle placement, bag fills somewhat slowly but I make it to the full 450mls —> Win

Sometimes I have the perfect needle placement, the bag fills in record time, there is no splatter and are no mistakes and I have the full 450mls —> Win, No-hitter

Kansas City Royals v Boston Red Sox

BOSTON – MAY 19: Jon Lester #31 of the Boston Red Sox reacts after throwing a no hitter against the Kansas City Royals at Fenway Park on May 19, 2008 in Boston, Massachusetts. (Photo by Jim Rogash/Getty Images)

Sometimes I know I missed the vein at first but am able to reposition and squeeze a full bag out of the donor —> Comeback win

Sometimes I miss the vein but am able to get help from another tech who can come in and reposition the needle to fill the bag —> Bullpen win

Sometimes I start off with the needle placed properly but the arm moves so the blood flow starts to slow.  After letting this happen for a while I reposition and am able to finish strong —> Rain delay, win

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Rain delay Fenway Park in Boston Wednesday, May 18, 2011. (AP Photo/Elise Amendola)

Sometimes I get the needle in but the blood is flowing so slowly it clots in the line collecting only 50 or so mls in the bag —> Rain out, game postponed

Sometimes I miss the vein.  I try to reposition with zero success.  I call for help.  My other techs cannot get the blood.  We all finally throw in the towel and give up —> Loss

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Those are the different situations I can find myself in while attempting to draw blood from our wonderful crew members.

In addition, I see veins as my different pitching options.

Center AC- Fastball, obvious choice but some days the batter will hit it out of the park all day long and in this analogy where I’m the pitcher the last thing I want to do is throw home run balls.  I’m forced to stick with the curve: the cephalic (side vein).  It doesn’t anchor well but for some reason is untouchable – like A 23 year old Beckett pitching a two foot breaking ball for the Marlins in the series against the Yanks in 2003.  I slide the needle right past and save the fastball for another day.

Florida Marlins celebrate

BRONX, NY – OCTOBER 25: The Florida Marlins hoist up pitcher Josh Beckett #21 the 2003 World Series MVP after defeating the New York Yankees 2-0 in game six of the Major League Baseball World Series on October 25, 2003 at Yankee Stadium in the Bronx, New York. Beckett pitched a complete game shut-out in clinch the series for the Marlins. (Photo by Jamie Squire/Getty Images)

 

But the real connection comes with the mental game.

Pitchers get up on the mound, throw out the first pitch and see where the game goes.  The first pitch and first few innings often set the pace of the game.  If it goes well the pitcher is in the zone and continues to throw outs.

However, if it starts off poorly the batters can get into the head of the pitcher.  Each hit builds on the one before.  Pitches aren’t placed where they are supposed do.  The fastball doesn’t have enough on it.  The curveball hangs.  The pitcher looks over and sees the pitching coach on the phone in the bullpen.  He knows he’s on his way out.    Slowly the manager makes his way out to the mound.  The only things left to do is hand the ball over and hope for the best.

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The pitcher is then left to sit with this for the next five or so days until he can once again stand on that mound and face the next batter.  Whether throughout the game or between games in a pitching rotation, success builds on success but failure tends to pile on failure.

The same goes with blood collection.  The more clean “wins” I get in a row the more confidence I have.  The more “losses” or even “bullpen wins” I get, my confidence slowly fades.  It gets to the point that I can’t even strike out a blind man, figuratively speaking.  I just have to say, “Take me out coach.”

At this point really, the only thing to do is just keep trying.  Hoping the next unit will go a little better.  Slowly, I make my way back.  The draws may not be pretty but each win is positive reinforcement and once I get into the zone a winning streak can last for weeks.

So thank you to my losses who put up with the errors and discomfort. Thank you for my rocky wins to let me back in the game. Thank you for my bullpen who have come in a saved the day and thank you to my no hitters out there who build my confidence more than anything.  This ship could literally not operate without you all.

Photo Credit Katie Keegan

Patient Sambany with 14 of his 17 total blood donors.  Read his story here. (Photo credit: Katie Keegan)

 

And remember, in life, baseball and blood collection – You win some, you lose some and some get rained out.

GO SOX!!

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From Cookies to Cars…

…QC: The Necessary Hassle

When I tell people I work in a laboratory which includes chemistry they usually picture the “crazy scientist” wearing goggles and a white coat behind a bubbling flask.

"THE MUPPETS"..Ph: John E. Barrett..© 2011 Disney

This could not be further from what I do – especially in the world of clinical chemistry.

Chemistry in a hospital or clinical setting is more about numbers and charts than anything else.  It is about Quality Control (QC), Calibration, standard deviation, numbers, graphs, trouble shooting and this set of rules developed by a man named James Westgard.

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   This is James

In a large lab with a high volume of work, values are evaluated and charted on every test every few of hours.  In a smaller lab it may be done once a day.  Here on the Africa Mercy we chart some tests daily and other tests weekly so we don’t run out of supplies but none the less the quality control is run, evaluated and documented very often.

QC is to make sure your instruments and reagents are working.  Once the numbers are acquired they are plotted on levey-jennings charts and evaluated for patterns and outlying results.  If any one of six Westguard Rules is broken (the value is too far away from the mean, the values are too much on one side of the mean, the value is too different from the previous day’s value, etc.) the problem has to be addressed and fixed until the results are no longer in violation.

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Some people love this aspect of the job.  For me it is my least favorite.  Give me a microscope over math any day.

However, after listening to a talk the other day, I realized that just like in other industries where QC is performed on everything from cookies to cars we should be performing QC on our lives as well.  In chemistry, QC is performed to ensure that results are valid.  What does this look like in life?

In life, the amount of time I spend reading my Bible, God’s instruction manual and love letter to guide my life, correlates to how much I can trust my decisions and know that the results of my life are valid.  Spending time getting to know my Savior is my Quality Control and He commands me to do this daily.  I have to daily chose to follow him and his commands.  It is not a onetime action, it is a daily commitment, a daily decision, a daily action to follow him.

“These commandments that I give you today are to be upon your hearts.  Impress them on your children.  Talk about them when you sit at home and when you walk along the road, when you lie down and when you get up”                                                                                                                                                                   – Deuteronomy 6:6-7

“If anyone would come after me, he must deny himself and take up his cross DAILY and follow me.”                                                                                                                                                                      – Luke 9:23

Data is not put on charts and there are no calculations but the only way I am surviving each day is to daily spend time with God.  The only way I know that at the end of the day the results of my thoughts and actions are valid is if I have spent time and actively made the decision to follow the Lord throughout the day, starting with a daily check in his Word.

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the hiding culprit

Growing up I was a champion hide-and-seek player.  Maybe it was because I was small and could fit into small spaces.  Maybe it was because I had more patience than others.  Often, it was just because I knew where to look.  Lately, this skill has come in useful in the lab onboard the Africa Mercy.

Sometimes a patient will come in and you have no idea what is wrong with them.  The labs don’t make sense, the symptoms don’t make sense and unfortunately we don’t all have House, MD showing up with the answers.

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Eventually it clicks – a parasite is found and it all makes sense.  Maybe in Africa this should be my first thought and it certainly is now.  I am seeing things on a daily basis that I only ever saw in textbooks or on “teaching slides” when learning how to identify certain organisms.

Now that we are suspecting parasites the reverse happens as well.  The doctors, nurses and I in the lab will have a pretty good idea of what is going on with a patient but we cannot prove it.  Enlarged spleen, grossly anemic, low platelets, no other explanation – “I bet it is Schistosomiasis” – a disease caused by parasites in the genus Schistosoma.  S. mansoni has been the most common here in Madagascar. 

Schistosoma mansoni

Schistosoma mansoni

But if that is the case than why won’t the little bugger show itself.

It becomes a game of hide-and-seek and I am not a very good looser. The game has multiple players.  Sometimes I’ll find Schisto’s friends…

Ascaris lumbricoides (roundworm) and Trichuris trichiura (whipworm)

Trichuris trichiura (whipworm) and Ascaris lumbricoides (roundworm)

Necator americanus (hookworm)

Necator americanus (hookworm)

but I know they aren’t really the culprit.  Schisto is still hiding and I will not be defeated.  I continue to scan, make concentrations and scan some more.  I use an iodine stain to make things more visible.

Sure it takes a couple hours to do a full ova and parasite workup on a patient (I’ll let your imagination fill in the specifics of where the specimen is coming from) but I love every minute of it.  Finally there it is, Schistosoma mansoni, sometimes by itself and sometimes among friends.

Schistosoma mansoni and Ascaris lumbricoides

Schistosoma mansoni and Ascaris lumbricoides

There is something so satisfying in finally finding the parasite after scanning multiple slides for an hour.  It validates not only my time but my knowledge as a lab tech.

Victory!

On top of the personal victory in hunting down the darn thing there is victory for the patient who can now receive proper treatment.  According to the CDC, Schistosomasis affects more than 200 million people worldwide and is one of the world’s Neglected Tropical Diseases (NTD).

NTDs are a group of infectious diseases that are the source of tremendous suffering because of their disfiguring, debilitating, and sometimes deadly impact. They are called neglected because they have been largely wiped out in the more developed parts of the world and persist only in the poorest, most marginalized communities and conflict areas – CDC

In finding the parasite (and friends) we can then accurately treat the disease and help bring healing to the patient beyond their surgery.  Mercy Ship’s mission is to “bring hope and healing to the world’s forgotten poor.”  This is healing in every aspect of life – spiritually, mentally and physically.  I am so thankful I can be a part of this healing process.

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saved by an army

For the life of a creature is in the blood – Leviticus 17:11

There is life in the blood – this verse took on new meaning to me when I became a lab tech and started to work in blood bank.  There are many things that have to function properly to keep you alive but one of the most basic is your need for blood.

The little complex cells carry oxygen to every inch of your body – every organ, every tissue – and nothing will work properly if there is no blood.  Luckily for us, God designed our bodies to be able to receive and use blood from another person.  All a patient must do is consent and let the army of blood donors take care of them.

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With that in mind, this is the story of Sambany and his walking blood bank.

Sambany is a name I first came across when his CBC (complete blood count: measures your red blood cells, white blood cells, platelets, hemoglobin and hematocrit along with some other things) came into the lab from screening and admissions down on the dock.  Sambany’s hemoglobin was 3.8 g/dl.  Just as a point of reverence a normal hemoglobin is 12-16 g/dl and is a measurement of the oxygen carrying capacity of your blood.

3.8 is by far the lowest “walking hemoglobin” I have ever seen.  By that I mean this patient was not brought in by ambulance bleeding out in the emergency department.  He walked (or was carried/driven) to the ship.  He walked up the gangway and walked down 2 decks of stairs for his CT and admission into the ward.  When I see a number like that I wonder how it is possible.  At home I would question contamination from an IV line since surely this man was not standing upright with a third less hemoglobin than normal.

MGB150121_SAMBANY_PAT16203_JF0014_LO

Without knowing anything else about this man or why he was coming to the ship I asked my techs to get a quick blood type on him just to see what we were dealing with.  Luckily he is an A positive – a blood type that is very common.  We reported the hemoglobin back down to the dock and found out if the doctor was planning on transfusing any blood and if so how much.

Sure enough, three units of blood were ordered for Sambany.  By this point I found out that this patient had been traveling for three days with a tumor twice the size of his head which he had been living with for 19 years.  The next step for us in the lab was to see how many units of Apos blood were collected and banked, how many donors were already tested and ready to collect and how many donors had volunteered.

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Here on the Africa Mercy all of the blood for the surgeries is donated by crew members and it is part of my job to manage this unique blood bank.  At home when I realize I am going to need more blood for a patient or a particular surgery I call local hospitals to see if they can spare any or call the Red Cross and have them express deliver the exact amount of units to the hospital.  Here when I need blood I go up to the café or dining room or pool or into the hospital and start tracking down my donors. “Has anybody seen ________, I need his blood?”

Over that night and the following few days 5 units of blood were given which raised Sambany’s hemoglobin to 8.9 g/dl.  Once surgery was scheduled we started planning for how many donors we would need.

Initially we were asked to crossmatch 8 units of blood – some fresh (donated the day of surgery) and some banked.  I started lining up donors and setting up appointments for them to come in the day of surgery beginning at 0830 in the morning.  Throughout the day the anesthetist was slowly requesting unit by unit.  The surgery was going well and despite being a vascular tumor the bleeding was under control.  As the surgery continued we waited patiently for the tumor to be out.

Photo Credit Katie Keegan

After dinner things started to pick up.  We had arranged for two more donors to come in and donate more as a precaution overnight but those units quickly were brought to the OR as well and they asked for two more.  At this point most of my donors who had been “on-call” during the day had scattered and I started finding anyone on the ship I knew was an Apos.  Luckily we have an early curfew and everybody has to be back onboard by 9pm.  I found a few more donors however these units were quickly picked up by the anesthetist and brought into the OR.  It was almost 10 o’clock at night.

Rachel, the maxillofacial team leader, who was also waiting for Sambany to be out of surgery so she could admit him back to the ward walked past the blood drawing room.  I looked at her and said “Rach, you’re Apos, can we take your blood too?”  She enthusiastically agreed and as we were collecting her unit the anesthetist came for one more unit and to inform us the tumor was out.  After Rachel the last unit I drew was from Kirstie, our hospital director, who I called in her cabin to come down at 1030pm to donate her blood.

Over the course of that day Sambany received 11 units of blood in the OR – 8 fresh, 3 banked.  He received another unit the next morning to bring his total from time of admission to 17 units of blood all donated by our amazing crew members.  These 17 units came from crew from six different countries (US, Canada, UK, Australia, Norway and Malaysia) working in departments on the ship ranging from hospital to hospitality, sales to security and things in between.

Photo Credit Katie Keegan

Sambany with 13 of his blood donors

Sambany with our lab team

Sambany with me and my lab team

After the 7.46kg (16.45lb) tumor was out and we were finishing up in the lab I was thanking Rachel for donating when she looked at me and said, “Thank you.  You guys are the ones who kept him alive.”  While this is possibly the nicest thing that has ever been said from a nurse to a lab tech and I appreciate it more deeply than she understands it is the amazing crew who kept Sambany alive.  Without their blood he would have died.

Photo Credit Katie Keegan

first time seeing himself after surgery

The life of a creature is in the blood.  While this verse is talking about sacrifice, atonement and foreshadowing Christ’s own blood given as a sacrifice for all of our sins, the fact remains the same – the life is in the blood.

Thank you to the army of blood donors who helped keep this patient and all our patients alive and who make these life changing surgeries possible.

Photo Credit Katie Keegan

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