Thrown Into the Deep End

I was a senior at Texas State when COVID-19 hit. Seniors usually start their clinical rotations in the Spring semester and continue through the summer, right up to graduation. The faculty in my clinical laboratory science (CLS) program had made us aware that our clinical rotations would essentially be a weeks-long job interview. We would have the opportunity to see a variety of labs in the central Texas area and, upon graduation, we would have made countless connections and have a better idea of where we might want to apply. The pandemic made that harder because I didn’t get a chance to see as many clinical sites as I would have liked – I only did three out of the six or seven clinical rotations that were scheduled that year.

Two were before spring break and one after when students were allowed back onto clinical sites. The final rotation was an experience I will never forget. Everyone was trying their best to keep up with wearing masks, isolation precautions, disinfecting above and beyond the norm, and, of course, the unprecedented pace. One day, I was told to retrieve a chemistry reagent for the analyzer from one of the lab’s refrigerators. As I opened the door, there was a large double-bagged object on the shelf among the normal things that one would find in the fridge. Upon closer inspection, I realized that it was a baby’s corpse inside. I was completely taken aback. I asked my preceptor what it was doing in there, only to be told the freezers in the hospital were at full capacity and this was the only place they could find to hold a body that size. It was an incredibly stressful time.

Taking the plunge

Upon graduation, joining the workforce in the middle of the pandemic was pretty intense. Some of the job applications I had sent out were essentially cold calls because I didn’t have a chance to make any connections. I was applying for jobs before I had even graduated with my diploma because I was tired of being in quarantine; I wanted to get right to work. I ended up securing a job in a hospital in my hometown and had my pick of departments because they were all desperate for staff.

I hit the ground running by choosing to start in the blood bank, at which point we were at the height of convalescent plasma therapy for COVID-19 antibodies. Everyone was grappling with adapting new procedures and paperwork for the clinical trials and questioning the efficacy of the products.

Before a lab can start running a new test, the technical specialists have to ensure that quality control is in place and everything is working properly, and usually there is a grace period where the rest of the staff can take the time to absorb that information. But that wasn’t the case here. There were many questions about how it could be used despite the FDA not having authorized its use, what paperwork was needed to ensure proper documentation, and most importantly, how it would affect the patients. There were also conversations about how additional plasma may affect the patients’ coagulation tests or what antibody titers would even be necessary in these units to elicit an immune response strong enough to the point of being therapeutic. We were already seeing weird results from COVID-19-positive patients, but there was no time to question it: only time to adapt.

We saw the rise and fall of this practice as well. Once the official studies revealed that COVID-19 convalescent plasma was not effective, its use was stopped abruptly. It was taken off the blood bank shelves and sent back to the blood donor centers. We would still get calls from physicians trying to obtain these units, but we had to tell them how these “treatments” were no longer being considered.

Lessons learned

At the time, I also had to work through what my facility called a “Critical Staffing Shortage,” so I chose to volunteer over my 40-hour work week to pick up additional eight-hour shifts at a sister hospital of my main facility. Working 16-hour days in a medical laboratory during COVID-19 was an arduous and emotionally taxing experience. The relentless influx of samples, constant pressure to deliver accurate results, and underlying fear of potential exposure took a toll on my physical and mental wellbeing. It was a trial by fire that really got me up to speed with the pace of the medical laboratory.

The pandemic was, at least, good for shining a light on our profession. Yes, we processed COVID-19 tests to determine whether patients were infected with the novel coronavirus, but it also opened up the dialogue on how we do much more than that. We test patient blood, tissue, and other samples for signs of other diseases to help diagnose and treat a myriad of medical problems.

Everyone around me appeared to be perplexed by abnormal results in coagulation. It was unclear at the time if these were related to the convalescent plasma therapies, but there was definitely a jump in the amount of critically high D-dimers, fibrin/fibrinogen degradation products, and fibrinogen results that we were reporting – and everyone took notice. We just wanted to provide the best care for all the patients coming in. I also discovered that someone can be in a profession for 40+ years and still get stumped. Evidently, the COVID-19 pandemic added another level of mystery. It wasn’t only about combating the virus – it was about applying methods effectively while people were dying by the hundreds of thousands. It was up to the exhausted but determined medical community to figure out the complex questions without losing their own lives.

It’s fair to say I had to learn to work quickly and independently – almost certainly at a much faster pace than I would have at any other time in my career. The sheer volume of samples we were having to process each day combined with the staffing shortages resulting from multiple pandemic-induced furloughs did not leave much room for error. I learned the importance of taking notes and being confident and self-sufficient. Typically, I would prefer asking a senior professional how to perform a task and being walked step-by-step through a procedure. During COVID-19, I wasn’t afforded such a luxury. I had to adjust quickly and be confident in the decisions I made while maneuvering through the hierarchy and intricacies of the clinical setting.

No book or lecture in the world could have prepared me for my first year on the job.