a seven-year bitch

OK, steel yourself - this is gonna be a long one. Here's the kind of day I had today at work:

First, this morning, we had a larger-than-usual batch of urines to go in the Coral machine. This is the machine we use to test people's urine for the presence of bacterial ATP using firefly juice - I'm not even kidding! We get this powdered luminescent substance from fireflies, Luciferin, to which we add a buffer containing the enzyme Luciferase (which helps make the Luciferin glow using the stored chemical energy from the ATP), and we use the resulting solution to check people's pee for bacteria. Seriously. This is SCIENCE, people! Anyway - big batch of urines to go in the machine. I get them all set up, and then I check our reagents - the firefly juice, which is supposed to be clear, instead has chunks in it. WTF? I check with the tech in charge of the Coral machine, M.S. (who, incidentally, shares a name with a well-known "domestic diva" television personality), and she says to pitch it and mix a fresh batch. I got the stuff out of the walk-in fridge, but while I was waiting for it to warm to room temperature before mixing it up, she went and did it for me - so impatient she is, when it comes to her precious machine. I mention her actions not entirely to be catty, but mostly to set up this important twist in the story: I was about to put the fresh batch in the machine when I saw that it had the same clumping problem, so I checked the expiration date (which I was about to enter into the machine in preparation for its self-check cycle). February 2006. No wonder the stuff didn't look right!

So not only had M.S., in her haste to mix the solution, not noticed that it was expired, but the night shift people who had mixed up the previous batch didn't notice, either. They hadn't changed the lot number in the machine - and they wondered why their results were so screwed up, starting last night when they put that batch in. M.S. checked the remainder of our reagent supply, and it was all from the same lot - all expired! How does a whole box of reagents expire in the walk-in fridge, yet continue to sit there for five months without anyone noticing? We had to pitch the whole box, and that's just a shameful waste. The firefly juice is not cheap, so it's costing the company money - and that stuff is not synthetic! They still have to harvest it from fireflies! (Don't ask me how they do it, but that is what M.S. told me they do.) F'cryin' out loud!

So since we couldn't use the Coral machine, that meant I had to plate every. single. urine. that came in today (and I had to toss all the tubes I'd set up for that first big Coral run - that was half an hour wasted, there). Usually most of the urines go through the Coral, and then I only plate the ones we know have bacteria in them. It wasn't that big of a deal, because it takes all of two seconds to plate a urine, but still - it's something that, with proper oversight, shouldn't have happened.

The next thing that happened was with callback, which is this ridiculous thing they make us do - certain test results get flagged to be called back to doctors, either because they've requested it, or because some other arcane thing in the system gets activated when the result is entered... whatever. Point is, callback is a clusterfuck, especially on weekends when most doctors' offices are not open to receive these callbacks. So, if you're really lucky, and it's Saturday, you will be able to catch a couple offices that are open in the morning, and you can give them the results with no hassle. Or if the office isn't open, you'll get the answering service, who will page the doctor, who calls you back promptly and takes the results gratefully. If you're not so lucky, the doc either won't call back (because it isn't his patient you're calling about, it's the patient of whomever he's covering for, so he doesn't really care), or if he does call back, he's all "why are you paging me about this?" (Oh, and it's always the male doctors who are pricks - the women, even when you can tell they don't want to be talking to you, are at least civil about it.) Or, in the worst-case scenario, you can't get in touch with anybody - the phone just rings and rings, no one picks up, no answering service, no answering machine, no surly doctor, and there's no alternate number listed for that physician, not even a fax number where you can at least send the results to CYOA (Cover Your Own Ass, one of the central tenets of contemporary healthcare delivery) and check the patient's record off your to-do list. Seriously, what the hell kind of doctor's office doesn't even have a machine to pick up that says, "We're sorry, the office is closed right now. Please call back on Monday."?? Oh yes, callback - it presents its own unique kind of horror, because you never know what you're going to get. You could get an easy list of calls and be done with the whole sordid business in about an hour - or you could get stuck in an all-day purgatory of phone tag and waiting around for the on-call to deign to contact you. And this mess is all on top of the specimen-wrangling which makes up the bulk of my job - so I've got to field all this stuff on top of receiving the usual drops from the hospitals, which need to be processed right away. It's a big PITA (Pain In The Ass), is what it is.

This weekend I got three annoying callbacks (at least it was only three!). One of them, there was no answering service, just a machine message with a pager number to call to allegedly reach someone, plus a different pager number in the patient's record which I could try. I tried both pager numbers and never got a response - but at least this record had a fax number attached, so while I couldn't mark the callback as completed, I could note that I had sent the information out in a timely manner (remember, CYOA). One of them was the dreaded no-answer, no-machine, no-fax deal, so I couldn't even get this information out to anyone at all. The best I could do was note that I'd tried repeatedly, then leave the thing uncompleted for them to deal with on Monday. The last one was a new twist on the surly on-call doctor routine. On Saturday I called the number in the record, got the answering service, and they told me Dr. Doofus was on call for the patient's doctor, and he would call me back. He didn't. So I tried again today, same thing, answering service told me Dr. Doofus would call. A few minutes later, the answering service calls me back and tells me that Dr. Doofus told them to tell me that he didn't want the results because it wasn't his patient and he couldn't do anything about the results. Say what? That is the first time I've ever heard that line out of a doctor. If you're covering for another physician, you take the results for their patients. That's just what you do. Even the answering service seemed kind of taken aback by Dr. Doofus's refusal to call me. But whatever, I had already faxed the results to the patient's regular physician's office, so I could at least note in the file that Dr. Doofus had refused my call, and get on with my day.

So I'd moved on, I was elbow-deep in something else, I was trying to get through the noon drop so I could go to lunch, when one of the techs comes out of the virology room asking if anyone paged a doctor about a patient of this other doctor's, and I was like, well, I did - but I thought that whole matter was all settled already. Is it Dr. Doofus calling me now? I thought he said he didn't want the results. Why is he calling now? And why is he calling on the phone in virology?? That's not the number I gave the answering service. So I drop what I'm doing and go back there to take the call. It's Dr. Doofus, finally calling me back - but the computer in virology doesn't have the callback program on it, so I can't pull up the results I'm supposed to give him. I have to put him back on hold (which, generally, really cheeses doctors off and tends to increase their surliness), transfer the call up to the main desk, run out there and pick it up, then wake up the hibernating computer (which takes for-ever), start the callback program, log back in... except that the callback program picks that exact moment to refuse to load on my computer, for absolutely no discernible reason. AARGHH!!! So, rush to the other computer, wait for it to wake up, load callback, log in, search for the patient's record, pull it up, finally give Dr. Doofus the results... and then he asks for the patient's phone number. Which, when I am doing callback, I usually look up beforehand, because I know doctors often ask for the patient's number. I have to use a different program to pull that information up, so if I do it beforehand, I won't have to keep the doc waiting while I start up the other program, log in, search for the record, etc. In fact, when I had originally done this callback, yesterday, I had looked up the phone number and had it ready to tell the doc. But he never called, and, thinking the matter settled, I pitched the info. So I had to make him wait through the whole rigamarole of pulling that file up. And in the end, he wasn't nearly as surly as I expected him to be, after all that waiting. But if the whiny little cretin had just called me back when I first paged him, the whole transaction would have been completed in a fraction of the time, and we could both have been on our merry ways. It still bewilders me that he decided to call, like, an hour after saying he wouldn't call - and of course, he had to call when I was smack-dab in the middle of doing something else! I mean, sheez. WTH, y'know?

There was a bunch of other little things that happened on top of that - like, to the point where I just started laughing, because dude. Ridiculous. There was a specimen from Thursday for which we had the work card but which hadn't been plated, so I got to hunt it down. That's par for the course, but usually I can actually find the specimen. Not so, in this case. But I got to dig through two big buckets of little cups of poo and pee and other pleasant things searching for it. Since it was nowhere to be found, we concluded that we must never have received the specimen, and we'd have to call the doctor's office and tell them to send it to us, at which point the whole affair became Monday's problem (yay!). There were a bunch of blood agar plates in the lot we're currently using which were hemolyzed, but before we can pitch the plates that we can't use for whatever reason, we have to note on a log sheet the manufacturer, lot number, date, how many plates we can't use, and why (whether they're cracked, contaminated, hemolyzed, etc.). It's important to do, but it's also annoying to have to keep stopping in the middle of plating to log the dud plates. And then every single drop seemed to bring at least one specimen which had leaked in its transport bag - which, in addition to being icky and a pain to clean up, makes it very hard to get our barcode labels to stick to the containers (which are damp not only from the leaked pee/poop/sputum/etc., but also from the bleach solution I have to use to clean them off). And then the perennial frustrations of my job: if you want a fluid culture, send us the fluid, not a swab; the phones never ringing when I'm sitting beside them with nothing to do, but going off every other minute when I'm busy doing something; the work card printers continually spitting out crap at you when you're trying to sort specimens as fast as you possibly can; etc.

Oh, and while I'm at it - Dear nurses and other specimen collectors at St. Joe's, Crouse, and Community General hospitals - a brief list of Do's and Don't's for you:

Do close all specimen containers tightly. I know you need to work fast, but think how much more time it will take you to re-collect the specimen when we call and tell you we can't do the test because the entire specimen leaked into the transport bag.
Do make sure the specimen labels are adhered entirely to the containers so that they don't become stuck to the plastic biohazard bags during transport and thus impossible to remove from said bags once they arrive at the lab.
Do send the correct specimen for the test ordered/ order the correct test for the specimen you're sending.

Don't use up all the little stickers labeling the containers and biohazard bags (we need those things sometimes!); but if you do use them all...
Don't send us the leftover sticker backing. Just pitch it, sheez.
Don't send us the plastic wrapper that the swabs come in. What on earth do you imagine we need that for? It's just one more thing we have to throw out.
Don't put the requisitions and labels in the biohazard bag with the specimen (especially if you choose to ignore that guideline about closing the specimen container tightly) - that's why there's that handy pocket on the outside of the bag.
Don't order a damn fluid culture and then send us a swab.
Don't order an anaerobic culture without ordering the accompanying aerobic culture. We can't do an anaerobic culture alone.

There, you see? None of those are particularly challenging or unreasonable requests. And those few simple things would make my working life so much more pleasant and efficient.

Alright, I just wrote a damn book (mad props to anyone who has made it this far), but I just had to get today off my chest. For all that I just spent this whole post bitching, today wasn't really that bad. I have certainly had worse days at work. I guess today's frustrations and minor nuisances were just different enough to merit further attention. And now, I'm off to bed.