Narrative Report: Medical Technology Internship
by Morena Dail
Clinical Chemistry is an applied science where analyses are performed on body fluids or tissue specimens to provide important information for the diagnosis or treatment of disease.
As soon as a specimen or blood sample is received from the extraction area or from the lab ad, correct patient information shoud be highly taken into consideration. The labeled name on the tube should match the patient's requisition form, otherwise the specimen is rejected. Afterwards, the sample is prepared for spinning (i.e. centrifugation) and a sample ID is now provided. It is always recommended again to make sure that the name on the requisition form is the same on the tube before numbering it. Also, it is better to number first the requisition form and the tube before writing it on the workbook to avoid mismatching. Patient name, room ward, test requested and the billing information (NBB - no balance billing, PHIC - PhilHealth Insured, etc.) should be written and recorded. After which, the specimen is dispensed to a well and fed to the chemistry analyzer. The ZCMC now employs the use of sample barcodes to avoid less error. After sometime, the staff will now process the results from the computer and eventually print a final copy. The results will now be recorded on the red logbook. After recording, upshots of the results will be done and the staff will have to sign the results, before releasing and segregating them to their respective wards.
In a brighter light, I have somehow improved my skills in venipuncture, although some patients have made it more challenging. When I was tasked to go on warding with a staff, I honestly experienced some level of difficulty in obtaining blood - whether it would be from a geriatric, mentally incompetent, ambulatory individual, or even a child. Albeit the stress-inducing experience, I am thankful enough because I have truly honed my skills in dealing with these kinds of patients. It also meant putting myself in their own shoes - I knew I had to obtain the blood samples as soon as possible but I still had to practice and observe patient care. It dawned on me the importance of avoiding traumatic draws and to see to it that I would be able to carry out my task without causing the patients any harm or discomfort.
Furthermore, I learned to value every sample or specimen as my own or as a family member's. Thus, in my four weeks in the clinical chemistry section, I learned to be more cautious and be more wary of my work - I learned to strive more for perfection. I learned that there should be no room for mistakes because a simple error could mean a lot. A simple mistake as mislabeling or misidentification could be grave enough to put someone's life at risk. Instead of providing benefit for the patients, we would most likely shove down knives down their throats. Indeed I appreciate and love how Ma'am Purita, had always emphasized the importance of making minimal or possibly no error at all. It has served as an important reminder to us to be better future medical technologists since clinical chemistry is prone to commonly encountered errors - pre-analytical, analytical, or post-analytical. Pre-analytical errors may include improper patient preparation, mislabeled specimen, incorrect order of draw, incorrect patient identification, wrong specimen container, etc. On the other hand, analytical errors may include improper incubation and timing, and incorrect volume of specimen and reagent. Post-analytical errors may include unavailable or delayed laboratory results, incomplete lab results, and wrong transcription of the patient’s data and laboratory results.
Although we never got the chance to use the Beckman chemistry analyzer, I am still grateful as seeing an up-close view of the machine was more than enough. The fully automated analyzer can run tests on the level of certain analytes, such as enzymes (e.g. amylase or lipase), non-protein nitrogenous substances (e.g. blood uric acid and creatinine), carbohydrates (i.e., fasting blood sugar), electrolytes (e.g. magnesium and phosporus), protein (i.e., total protein), lipids (i.e., cholesterol), and many more. On the other hand, the electrolyte analyzer can run tests on levels of sodium, potassium, chloride, and, calcium (total calcium and ionized calcium).
Test kits were also available including Troponin I and Troponin T - which are cardiac markers and Helicobacter pylori which is a marker of chronic gastritis. These markers, along with amylase and lipase, are considered STAT tests which require immediate testing.
I have encountered some interfering conditions in the measurement of analytes, such as hemolysis, icterus, and lipemia. Hemolysis is believed to contribute to a slight dilutional effect in the analytes present in the serum or plasma. Thus, I mainly took into consideration the effects of hemolysis like the false increase in the levels of certain enzymes, such as lactate dehydrogenase, acid phosphatase, and transferases, and electrolytes, such as magnesium, phosphorus, and potassium. Lipemic samples, on the other hand, can inhibit amylase, urate, urea, creatine kinase, bilirubin, and total protein. These interfering conditions could serve as grounds for specimen rejection.
Proper patient identification, which is the first step in sample collection, is the main step in providing accurate results. Likewise, proper techniques in specimen collection must be strictly followed including the observance of the confidentiality of results. Misidentification of patient, hence, is considered a mortal sin in the laboratory.
Every day here has always been a challenge. In all the endless recording, unanticipated scoldings that we sometimes get from the staff, and extra-chapters of reading for the shifting exams, we are always tempted to just leave them all behind and get the easy way out.
But despite all of this, I would still choose to risk my reputation, be a 'martyr' and do what I believe is right. It might sound too idealistic but having to practically grow up here in this internship program, made me realize one great thing in my life - purpose. I realized that my purpose is to become a great medical technologist and I realized that in order to achieve my dreams, I have to pay the price of burnt-out bodies and long sleepless nights of duty. I realized that my purpose is to achieve my dreams in the right way, the way that is both beneficial to me and my future patients. I realized that there is more to life than just mere numbers on the card that we should always work hard because we will soon be entrusted with people's lives. Maybe, it's not even being a martyr at all. It is being fair to yourself, doing what is right and fulfilling your purpose. There is always nothing to be scared of as long as you are doing the right thing. What is more haunting is crossing that thin line of pragmatism and apathy. After all, to be better future soldiers of the allied medical field requires 'blood, sweat, and tears.' It is worth the challenge!
I am greatly indebted to the staff of the clinical chemistry section for a month-long journey of learning. Moreso, I am honored to be part of this institution that has for years served as an avenue of opportunity for unbridled potentials.
