by Dave Spikey
Although that’s what a microbiology lab does, as a junior, of course, I didn’t get to do any of this very interesting detective work. Instead, I had to make up solutions and reagents and liquid stains. I had to boil, clean and polish the microscope slides, clean the benches and fume cupboards, autoclave the used glassware … and so on.
The only actual laboratory testing juniors got to do involved preliminary testing for TB. I don’t know why we got that job because it was quite important, but I suspect that it was because it was a horrible nasty job. We would receive from ‘Wilkinson’s’ – our outlying TB unit – metal tins which contained samples of patients’ sputum (that’s phlegm to you). We would sample a globule of sputum and spread it on a special nutrient agar called a Jenner slope and a glass slide, and then stain the smears on the slides with ZN stain. The way we did this was by placing them on a glass stand and ‘flaming them’ by lighting a wad of alcohol-soaked gauze, which was attached to the end of a metal probe. We flooded the slide with the stain and then heated the slide from underneath with the burning gauze until the stain bubbled. I set my hair on fire again doing this, tragically destroying what was left of my ‘Paul McCartney’ fringe.
A couple of years later, we had a junior called Janet, who knocked a Winchester of methanol over whilst flaming ZNs and set the bench and one wall of the lab on fire. She famously wandered into the main Bacteriology lab staffed with six technicians and said matter-of-factly, ‘Hey, kid, come and look at this.’
It was great fun in the TB lab in those days. Sean was rotated in and there was a girl called Elaine, a couple of years older than us, who was great fun. We used to tape a transistor radio to the fume cabinet in which we did all the TB culturing and we would sing along to the sounds of the sixties. I remember the great yet scary Dr Manning appearing at the door in the middle of a Beatles medley and giving us a death stare, which made us freeze with fear, and then saying in a totally deadpan manner, ‘Keep it down, will you, my patients are joining in.’
He was a great man, Dr Manning; he didn’t suffer fools gladly, but he acknowledged good work and rewarded you with a few well-chosen words of praise. Sean got on with him particularly well considering our lowly status. Whenever Dr Manning ventured into our lab, resplendent in three-piece suit, dicky bow and buttonhole flower, Sean would always indicate the flower and make up some preposterous botanical name, ‘Is that a roboticum siphillicum, Dr Manning?’ Dr Manning always permitted himself a little smile before putting Sean right.
Before I move on from Bacteriology, I must mention another job that came under my responsibilities and that was the collection of outpatient urine samples, faeces samples and seminal fluid samples – for which an appointment was required. This was all very embarrassing for a young man straight out of school, but I soon found it to be routine.
Instructions for a mid-stream urine? For a woman, issue a disposable bedpan, instruct them to wee a bit down the toilet, then a bit in the pan, then the rest down the toilet. Same for a man, except substitute a small glass bottle for the bedpan. Simple enough – although you could and did run into difficult patients.
I particularly remember one old man, who looked at the neck of the bottle and said, ‘I’ll never be able to get it in there.’
‘Not a problem,’ I said, producing a large plastic filter funnel, which I placed in the neck of the bottle. He grabbed my arm tight and it was only then that I noticed that he looked a bit strange. Time may have blurred my memory, but whenever I remember the incident now or recount it to friends, I seem to think he talked like a pirate.
‘That’s no good, either,’ he said.
‘Really?’
‘No, and do you know why?’
I shook my head and he came a little closer and said, ‘Because I’m a woman.’
Right, don’t panic; even though you’re in a toilet cubicle with a demented pirate, just smile and think of something appropriate to say. But now it’s too late because he’s saying, ‘I might be able to manage if you can hold it for me.’
‘What?!’
‘The bottle, I mean,’ he said, ‘because I am a woman.’
I’ll be honest; he didn’t look like a woman. He looked like a pirate. I just said, ‘Of course you are. I’ll just go and get some help …’
He gave me a twisted smile and said, ‘No, look!’ and dropped his pants – and I saw immediately what he meant when he said that he was a woman because he had no penis. Well, none to speak of. He had the testicles, but just a tiny stump where there used to be a penis.
‘I got it shot off in the war,’ he explained, and immediately I felt both ashamed and compassionate. ‘These little things are sent to try us,’ he said, and I apologized sincerely for my abruptness in dealing with him. I asked him about the circumstances surrounding the event and we chatted for about ten minutes before he had to go and he was such a kind, gentle old man.
Arranging the appointments or collecting samples for seminal analysis was also embarrassing, but it was the source of much hilarity too. Quite a few men, most but not all non-English speakers, couldn’t quite grasp (pardon the pun) exactly what I was telling them to do – and so I had to resort to mime, which would occasionally cause offence and heated argument. While booking in appointments, meanwhile, you might tell them to attend on Friday. They quite often said, ‘I can’t come on Friday,’ to which you might reply (childishly), ‘Well, that could be your problem. Don’t do it on Fridays.’ Others would bring in samples of urine and occasionally faeces, and you’d think, ‘No wonder you aren’t having any children!’
I rotated from Bacteriology into Biochemistry, where blood, urine, stomach washouts and other bodily fluids are analysed for their biochemical constituents. It was here that I first learned how to take blood from patients (phlebotomize). Small samples were obtained with a lancet from a thumb prick, and larger samples by venepuncture, using a needle and syringe to take blood from a vein in the arm. This was quite a traumatic and scary learning curve. We first practised on rubber tubes of various internal diameters, getting the angle of insertion right and making sure we didn’t go in too deep and go right through the other side of the vein. Then we practised on volunteer lab staff – or Junior Technicians as they were called; practically, each other! I had been volunteered many times and now it was my turn to tighten the tourniquet.
Eventually, of course, you were let loose on real patients, who had all sorts of dodgy-looking veins, flabby arms and needle phobias. I actually became very good at phlebotomy. I liked the patient contact, enjoyed the chat and the teasing – when we had to go on wards to collect samples, the gynaecology wards were the worst, with the shouts of, ‘Here he is with his little prick!’ ‘Don’t hurt me when you put it in,’ etc. – and it was very satisfying when you managed to get a decent sample from patients who were classed as difficult to bleed because their veins were hidden or stringy, or their arms were so flabby that it was difficult to get the vein stable.
I once had a bit of a trauma bleeding a patient in our outpatient department. I had almost finished and asked her to bend her arm up, but she reacted too quickly for me and knocked the blood-filled syringe and needle up in the air. Time went into slow motion as the syringe described a perfect parabola in the air before plunging back down towards the desk. Instinctively (madly!), I tried to catch it. I completely miscalculated its flight and made my grab as it landed upright on one end, with the needle pointing upwards on the desk. I didn’t have time to halt my interception and my hand pushed down hard on the needle (what were the chances of it landing vertically?). The needle pierced my hand through the skin at the base of my middle and fore fingers. The patient looked horrified and asked, ‘Are you alright?’
I smiled, grabbed the syringe and pulled the needle back out through my skin as if it was an everyday occurrence. I said, ‘What am I like? I’m always doing this.’
I’ll not dwell too much on the preparation of faeces for faecal fat analysis, or the pitfalls in the mouth
pipetting of stomach contents prior to testing for salicilates, but suffice it to say I’m pretty bloody sure that half of those laboratory procedures wouldn’t be permitted under the most lenient of health-and-safety procedures these days.
I was, after a suitable period of training, given responsibility for glucose tolerance tests (GTTs), which were and still are, I think, the definitive test for diabetes. Patients fasted overnight and a urine sample and blood test from a thumb prick were taken at 9 a.m. in the Outpatients’ Department. The results of the glucose level in these samples was taken as the base measurement and then the patient was given a glass of glucose solution to drink. I had to make this up by measuring out the glucose and diluting it with an appropriate amount of water. It was very sickly sweet and quite unpleasant, and we had to cajole some patients into finishing it off as we needed to see how the patient tolerated this massive increase in blood sugar. Five further blood samples and two more urine samples were taken over the next two and a half hours.
For my first session in charge of the GTTs, I had three elderly patients and the responsibility had made me very nervous. Anyway, it all seemed to go well and at twelve o’clock I returned to the Biochemistry lab with my eighteen blood samples (six per patient) and nine urine samples (three per patient), all carefully labelled up with times and names. One of the biochemists, Pete, took the samples from me and asked me how it had gone.
‘Good,’ I said. ‘Very good.’
He took out his pen and enquired as to what time exactly had I given them their glucose solution drink. Do you know when you get those icy fingers running down your spine that make you shudder involuntarily? And your shoulders sort of contract and your throat constricts and that awful feeling of dread and panic starts to rise up like a heavy cloud from the very core of your being, and yet your face just sort of goes a bit blank? That’s what happened to me then – because I’d forgotten to give them their glucose. I’d done the first ever glucose tolerance test without glucose!
Pete’s enquiring smile was now slowly fading as he started to detect the fear and panic in my eyes. He went ballistic. Fair play, he didn’t get me up against the wall like the mad bloke from Bugs, but he gave me a right royal bollocking, which only ended when he thrust the patients’ request cards at me and told me to rearrange the tests for as soon as possible.
And so it was that the three old ladies returned the following Tuesday and I found myself apologizing profusely for the ‘technical failure’ which had caused this to happen. ‘All this modern technology, eh? What can you do?’ So we started again. Because our outpatient rooms were rammed that morning, I had to conduct the tests in the packed waiting room. After the first blood and urine tests, I produced the glucose drink. One lady said in a very high voice, ‘Oh look! At least he’s giving us a drink this time!’ Another said, ‘No thanks, love,’ and the third said, ‘I’ll have a cup of tea, please, two sugars.’
I told them that they had to drink it and number one took a sip and pulled a face, ‘No! I can’t drink that! It’s much too sweet!’ The others concurred: ‘Too sickly.’
‘Look,’ I said firmly, ‘you have to drink it for the test.’ The rest of the patients in the waiting room stared at me in disgust.
‘We didn’t last time,’ one of my GTTs pointed out.
‘Well, you do this time,’ I insisted. I made them drink it, but they complained for the next two and a half hours, as only old ladies can. I didn’t care; I got it done.
I enjoyed Biochemistry on the whole, but it didn’t grab me. A lot of the senior staff were very stuffy and full of their own importance – mainly the biochemists. Clinical biochemists, in my experience, were pedantic, grey, humourless characters. Let’s put it this way: it’s no surprise that it was a biochemist who invented the laboratory dipstick.
They are notoriously obsessive about protocol, standard operating procedures and quality control. I performed at a clinical biochemists’ conference once and found that I had to tell one joke that was not very funny, one that was quite funny and one that was very, very funny; just so they’d have a low and a high control.
There were 300 biochemists at this conference; I’ll always remember that overwhelming smell of Old Spice and all that corduroy! I’d never seen so much corduroy in one room. And beards! I thought at first that they were all wearing balaclavas, but no; big bushy beards. I recall thinking, ‘Three hundred clinical biochemists at this gala dinner. Just think if they all got food poisoning and were off sick for a week; hospitals the length and breadth of the country probably … wouldn’t notice.’
There is a popular story that highlights the role of clinical biochemists, which goes like this:
Two hot-air balloonists, having been blown off-course, decide to land in a field and ask for help. Just as their basket has safely touched down, a man rides down the adjoining lane on a bicycle. One of the balloonists shouts to him, ‘Excuse me, but could you tell us where we are?’ The man on the bike stops and looks at them before shouting back, ‘You’re in a little basket.’ The balloonist turns to his companion and says, ‘He has to be a biochemist.’ His companion replies, ‘How can you possibly know that?’ and the first one responds, ‘One hundred per cent accurate, completely bloody useless.’
Next stop for me was Histology, a quiet backwater of the lab, where the highlights of the day were watching wax set and an afternoon game of shove-ha’penny. There were only three other staff in Histology: David was the Chief, Phil (who became a good friend) was the basic grade, and Joan did mainly cytology – cervical smears.
We received assorted bits of people from either the operating theatre or mortuary. The pathologist dissected the bits and the trained staff embedded these bits in wax, and then sliced them micrometres thin on microtone; a sort of ultra-sharp bacon slicer. These one-cell-thick sections were then placed on microscope slides, fixed and stained, so that the pathologist could examine them under the microscope and then provide a detailed report.
Again, as a junior, I didn’t get to do any of this! Much of my time was taken up preparing solutions, stains and reagents, and my main job was in the ‘cutting up’ room, i.e. the room in which we received and dissected the samples, which arrived in small jars, big jars, bowls, buckets and the odd bin (limbs, mainly). We used to play a game called ‘What’s in the bucket?’ which would make an interesting Saturday night TV quiz programme for Ant and Dec, I reckon.
My job was to receive the samples and arrange them in dissecting order – big organs first – and to prepare glass jars and small tickets, on which I wrote the patient’s reference number. You might need several per sample and experience guided you in this. An appendix, for instance, would usually only require one jar and one ticket, on which you would write ‘TOT in 4’, meaning it was the total biopsy dissected in four sections. A cancerous bowel, by comparison, might need four jars, with sub-reference numbers and descriptions for the suspect tumour and associated lymph nodes.
At the same time as I was frantically labelling my tickets, I was taking dictation from the pathologist on his findings during the dissection. This would include the description of the sample, the tissue changes and tumour presentation and much more. It was a frantic hour or two which put you under a lot of pressure. You simply could not afford to make a mistake.
I enjoyed Histology a lot. Apart from the cutting-up pressure in the mornings, it was a laidback sort of place. I was a little sad to leave, especially when I discovered that my next rotation would be in Haematology at Bolton General Hospital. This was two bus rides away and a lot less convenient than Bolton Royal Infirmary, but it had to be done.
Bloody Hell (Not)
IVIVIDLY REMEMBER walking into the Haematology lab on that Monday morning – and thinking that I’d found my spiritual home!
The Pathology Department at the General was a scaled-down version of that at the Infirmary, and seemed a warmer, friendlier and happier place. That said, I found the girls in Haematology and Blood Transfusion to be very
intimidating; they could unnerve you with the most withering of remarks. I once came to work in a new tank top (it was 1970, alright?) and walked straight into it. ‘That’s a nice tank top, Dave, is it new? It suits you … it’s plain, isn’t it?’
Another time, a new friend of mine, Glenn, who’d started a short time after me, was floored with, ‘I like your tie, Glenn. Isn’t it an unusual pattern? It looks like that wallpaper in Indian restaurants.’
They could cut you like a knife, but, in time, once you gave as good as you got, they became good friends and the banter was brilliant.
Haematology is the study of the disorders of the blood – so anaemias of every type, leukaemia, lymphoma, polycythaemis and thrombocytopaenia, as well as blood-clotting disorders such as haemophilia, Von Willebrand’s disease and so on. Most of the work was routine screening of samples from patients prior to operation, in pregnancy or referred from medical wards or GPs with a multitude of symptoms that might suggest anaemia, infection, inflammation and so on, or patients on anticoagulation who needed their clotting factors monitoring.
I was immediately gripped by it. I think part of the reason was that I could actually look down a microscope and see these cells, compare normal cell appearance and number with abnormal cell appearance, detect the presence of immature cells or changes in platelet numbers … I loved this hidden, fascinating world of haematology, which was only visible under the microscope.
Whereas in Biochemistry, by contrast, I could never see anything, so much so that I began to call it Alchemy. Okay, I’ll give you glucose, sodium, potassium, cholesterol … but gamma-glutamyl transferase? Pull the other one. They’ve made half of them up to expand the science and make themselves look important.
As a junior in Haematology, I still had to do all the basic jobs I’d done before, plus I had to spend most of the mornings on the wards and units taking blood from thumb pricks and prepping the samples at the bedside for the various tests required. Once we got back to the lab, all the tests could be run straight away as we’d done the prep as we went along.