Tortillas and Grapes: the nose knows

“Huh.”  Contemplating, that’s all I said when I uncovered the SBA plate. I was overwhelmed by a smell I knew. It was a smell that in all honesty started to make me hungry. It was the smell of tortilla chips. It was Pseudomonas.

Microbiology is the science that deals with microorganism.  It’s an invisible world brought to life where color explodes and smells are amplified.

As a second round of plastics begins here in Benin, the ORs are gearing up for more burn contracture releases and lipoma removals while the lab readies to be hurled into this world of colorful and potent, invisible life.

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©2016 Mercy Ships Photo Credit Justine Forrest; Dyllan with Grandmother in B Ward

 

In the Africa Mercy laboratory we are concerned mainly about aerobic bacteria and there are numerous steps we take to identify all the characters present.  One technique, unofficially, is smell.

So just for fun, here is a list of what my nose knows…

 

Pseudomonas aeruginosa: grapes or tortilla chips.

This has always perplexed me. In my mind these two things are nothing alike. Since I was 17 years old and taking my first micro class with Mrs. McBrien (shout out!!) I have always smelled grapes. The rich, sugary, children’s Tylenol, icy push-pop on a summer day, artificial grape smell. It overwhelms the incubator when it is growing.

As mentioned earlier, the other day I finally smelled the tortilla chips. I am now convinced that it is not a people smell one or the other sort of thing, but that different strains have different smells. The less colorful, not as impressive strains smell like a boring bowl of corn chips while the iridescent, multicolor strains take on the artificial grape smell – maybe

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Proteus species: sweaty socks or chocolate cake.

Again, how is this possible? What kind of chocolate cake are people eating that smells like a boy’s locker room? With this one my theory is the longer you work in micro the less vile some things become, so after a year or so the musky scent of Proteus does begin to smell like a dark chocolate cake. It’s weird, I know, but trust me it does.

 

Strep viridans and Group F Strep: butter.

This is another one to make your mouth water. When you get a pure plate of Strep viridans, you may as well have walked into a movie theater it smells so much like freshly popped popcorn. You can almost feel the grease as you swipe a colony for more testing.

 

E. coli: mothballs.

Take a walk through grandma’s closest and you are there. It is that strong, chemical smell that burns your nostrils.

 

Eikinella corrodens: bleach.clorox

Plain and simple, there is no arguing, everyone is in agreement that this one smells like a bottle of Clorox.

 

Last, but not least,

Staph aureus: Staph aureus.

I’m not sure there is another way to describe it.  S. aureus has a very specific spell but it does not smell like anything else.  Work long enough in a micro lab and you too will know what this unique smell is, as well as all the others.

Thanks for joining me on this journey into the incubator.

 

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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.

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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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Mercy Ships is…

Mercy Ships is community

Community is a place…

Where a box of cereal is left outside your door because your friends know that is the way to your heart

When somebody is having a birthday you can crash without anybody looking at you strange

You can end up taking a day trip with a group of people you have never met and have the time of your life

When you start watching a movie with 4 people you may end it with 24

You can post a desperate plea for a needed item on facebook and have the item by the end of the day

Community is a place where at any given time you can walk down the hall and hang out with somebody who is a nurse or a teacher or a writer or a student or a receptionist or an engineer or a cook or any job you can possibly think of.  Community is a place that everybody plays a part  – no matter how small or big you may feel – and with that I want to thank each one of my amazing lab techs who came to serve this past year in Madagascar

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Claudia – I have to start with you.  You believed in me enough to give your job to me.  You stuck around through months of delays so I would have at least a few weeks, or more like days, overlap when the hospital finally opened.  You patiently showed me spreadsheets and documents I didn’t understand that would later save me so many times.

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Kathy – you came when the ship was still in South Africa and we were assigned to the same dining room team.  You understood my “jam hands” comment and we bonded over our inability to pour sauce from one pan into another without making a mess.  You helped me set up the lab and transition into this role.  You were so patient with me as I figured out what the heck I was doing.  You let me draw my first blood unit off your arm and brought award winning Olaf to the lab (who by the way is still up on the wall).

Laura – I had just two weeks to train you and hand you the pager before you were no longer the new tech.  You were gracious and took on the challenge and then helped train Lise.  We could talk about movies and TV shows and your future and what that was going to look like and what surprises were going to befall you while here in Madagascar.

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Lise- I wouldn’t trade our time together for anything.  To be honest, there were times in the beginning I doubted that you’d ever be ready to carry the pager but in the 5 months that you were on the ship I saw you transform into not only a capable, confident tech but also a capable, confident woman of God and I am so thankful that I got to be part of this journey.  Your joy was contagious and the sheer fun you brought to the lab will not be easily replaced.

Leah – you brought so much pleasure, laughter and life to the lab.  You held down the fort and did all of the rest of our work and all 20 something crosshatches for Sambany (ready the account here) during those crazy days.  You had confidence and encouragement for me at just the right time and I don’t think you will know the impact that has had.

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Amie – you came to fill in that final hole in the schedule.  You were patient with me in the midst of total chaos when you first arrived and still at the end when all the work disappeared.  You had a great attitude through all the extremes of this place.

Photo Credit Kayla Hess

Photo Credit Kayla Hess

Thania – You sought out the ship to come and gain experience but you brought so much with you already.  You came at a time when the lab was so busy we barely had enough hours in the day to finish the work.  You lightened this burden to make life possible.

Photo Credit Justine Forrest

Photo Credit Justine Forrest

I thank the Lord for all of you and how you each played a part in this past field service.  You each touched my life in so many ways and I learned so much from you.

Thank you

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disclaimer

8 by Friday

Faith is an interesting thing, prayer even stranger.  To think that I can intercede on the behalf of another person to the almighty God for healing and not only believe it will have an effect but wait in anticipation for the results is nothing short of mind blowing.

There was recently a patient on the ward who underwent a total thyroidectomy back in February.  Unfortunately, in the process her parathyroid gland was disturbed and stopped functioning properly.  Why is this important?  The parathyroid is responsible for controlling calcium in the body.  Calcium is necessary for nerve communication and muscle contraction.

Photo Credit Justine Forrest, Dr AJ Collins (AUS) General Surgeon and Dr Shehnarz Salindera (AUS) General Surgeon PAT16147 Hanta

Photo Credit Justine Forrest, Dr AJ Collins (AUS) General Surgeon and Dr Shehnarz Salindera (AUS) General Surgeon 

This patient, Gloria*, was receiving copious amounts of IV calcium as well as oral and still she was symptomatic with labs well under the normal range (8.4-10.2 mg/dL).  Week after week she continued on the medication without seeing any results.  It was to the point that, in my opinion, all medical options were exhausted and still no improvement.

One Saturday evening I was praying for Gloria and I felt the Lord say “8 by Friday.”  If this was her calcium it was a great deal above what she had been running and frankly seemed impossible but who am I to argue with the Great Physician.  The following Monday the general surgery team leader informed me that the goal for this patient was to have her calcium reach 8 mg/dL by Friday.  I just nodded and said, “Yeah, I think it will be.”  Little did she know the confidence in which I was making this statement.

As the week progressed Gloria’s calcium was steadily increasing as her dose was also increasing.  By Thursday she reached 8.4 mg/dL.  We were all in awe.  Friday morning I eagerly awaited her result.  It was exactly 8.0.  I almost started crying.  However, in the days that followed her medication was weaned back resulting in her levels once again dropping.  Many people onboard were discouraged and doubted if she would ever be healed.  Gloria herself started doubting.  Sure, she was 8 by Friday but she was also on a mega-dose of calcium so those levels weren’t necessarily a reflection of her true condition.  For me though, it didn’t matter how she got there, God was saying “I’m still in control.”

Weeks went by and still no improvement.  “God, where are you?”  One night I was reading my Bible and came across this verse in the book of Habakkuk

LORD, I have heard of your fame; I stand in awe of your deeds, LORD. Repeat them in our day, in our time make them known; in wrath remember mercy.

Habakkuk 3:2

I heard God once again speaking to me, this time simply saying “I will heal her.”  I was overwhelmed and convinced that this would be my declaration the day Gloria was healed – I would stand in awe of the Lord’s deeds!  I have seen that God works on his own time table in his own ways and who am I to doubt or question.  The only thing I can do is pray and have faith in his Word and his promises.

Fast forward of few weeks and Gloria’s levels are once again rising.  This time her dose was either remaining the same or steadily decreasing.  She was taken off IV calcium and still her levels remained in range.  Her oral dose was decreased and still she was on target.  Last week Gloria was discharged.  The day before she was sent home there was a party on the ward for her.  Our physician who has been managing Gloria’s care for the last 4 months walked over to her and put her arm around her – Gloria had tears running down her cheeks.  I’m sure she thought the day would never come.  There were a lot of people on the ship who thought the day would never come, myself included.

Photo Credit Catrice Wulf - Ward nurse Maria Geary (USA) cares for patient

Photo Credit Catrice Wulf – Ward nurse Maria Geary (USA) cares for patient

Gloria is not totally off medication but she is now on a much more manageable, oral dose with continued improvement.  I know God is not done.  I know he will heal her fully.  I know that he does things for his purpose and his time so he receives the glory.

On the day she was discharged a friend of mine and nurse on the ward was excitedly saying she too was amazed that Gloria has finally been discharged and said “Doesn’t it make you want to say ‘Go team.’”  I looked at her and said “No, it makes me want to say, ‘Go God.’”

We had nothing to do with her healing and I fully believe that.

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*The patient’s name in this post has been changed to protect confidentiality of the individual.

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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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