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CHAPTER ONE It could have happened to anyone. I just happened to be on duty in the lab that night when the accident victim came in.
"Laboratory. Mister Brandon speaking," I said very correctly, when the phone rang, already guessing what it would be. Most calls to the lab at that time of night were from either the emergency room or the intensive care unit and I had been to intensive care already just a few minutes ago. The blood from that patient was already in the chemistry unit being analyzed.
It was the Emergency Room. I picked up the tray containing all the phlebotomy supplies by its handle, automatically checking to be sure I had enough of everything; needles, vacutainers, syringes for hard to get veins, special needles for the syringes, alcohol sponges, cotton balls, band-aids and so forth. Everything was there, as I knew it would be. Checking the phlebotomy tray was always the first thing I did when coming on duty; that and getting a fresh pot of coffee going. I'm a caffeine addict.
Most small hospitals try to have the lab and X-Ray departments close to the emergency room but with Lamont Memorial in Lufkin, that wasn't the case. The building had grown in fits and starts as medical care changed and technology advanced. The lab was up on the second floor and down a long hall from the elevators. Most of the time I didn't wait on the elevators; I was getting old and needed to exercise. Taking the stairs when I got called was one way of getting it.
"Hi Mike," Sandy Jervis, the charge nurse said. "Room one."
"Thanks," I told her, not bothering to ask what the problem was. It really didn't matter to me. As long as I had been in thegame, I had seen it all. Or thought I had.
The patient was lightly strapped to the gurney, with the ER doc and another nurse busy working on him. Carla, one of the nursing students, handed me the lab request forms. I glanced at them, then at the patient, and wondered what they wanted me for. The man on the gurney looked as if he were already dead. His face had that whitish gray pallor of death and I couldn't see his chest moving. His clothes had been cut away and a bloody sheet was pulled back up onto his chest, showing a massive trauma to both of his legs, as if he had been run over by a vehicle. The doc and nurse both had blood on them, a no-good way to be working in this day of AIDS, Hepatitis, Avian Pneumonitis and God knows what else the terrorists might be cooking up. The wounds had stopped bleeding and simply gaped open. I could see both the tibia and fibula, the lower leg bones of one of his legs. Both were shattered like someone had gone in with a big nutcracker and purposely crushed them.
"Is he still with us?" I asked.
"Barely," the doc said, then looked puzzled. "It's not typical shock trauma, but damned if I can find anything else wrong besides his legs. Witnesses said it was a high speed vehicle accident." I didn't know the doctor's name. The hospital used contract docs for the ER and they came and went oftener than new Medicare regulations.
Looking at the patient, I doubted there was much blood pressure and figured his veins would be hard to get into. I decided to go with a 20 cc syringe and 21 gauge needle rather than vacutainers or a butterfly. Hardly any of the younger techs even know how to use a syringe, but I think I mentioned earlier that I wasn't a youngster, not by a good many years.
The patient's vein popped up when I put the tourniquet around his arm, much more visible than I had expected. I had just gotten all the blood I needed and withdrawn the needle when the patient gave a sudden spasm. Both of his arms jerked upward at the same time as his feet began thrashing, as if he wanted to run somewhere. The leg with the broken bones bent at an angle that was normally impossible, making it look like it had been torn off and stuck back on with glue-but I wasn't noticing that. His forearm hit my hand where I was still holding a piece of gauze on the puncture site and knocked it up into my other hand, the one holding the syringe of blood. I felt the prick of the needle entering my wrist.
"Oh Goddamn!" I cursed loudly, jerking my hand away. The needle pulled out of my wrist but it was already too late, of course. If the patient had an infectious disease that could be transferred by blood, I probably had it now too. I had been holding the damn syringe at just the right angle for the force of the patient's arm to cause me to press on the syringe plunger, injecting a bit of his blood into my system.
The doc and the nurse were busy trying to keep the patient from falling off the gurney and at the same time realigning the broken leg with an air cast. They couldn't spare me a glance and I knew they were assuming my curse was simply a reaction to the sudden movement of the patient.
It had been a long night. I was tired and my feet were hurting and I didn't feel like filling out an incident report with all the time and paperwork it would entail. Besides, paperwork wouldn't do me a damn bit of good if I had caught something. I quickly transferred aliquots of blood to three different vacutainers, then removed the needle from the syringe, all the while concealing the dot of red on my wrist where the needle had hit me. I dropped the used needle into the disposal box, stripped off the disposable gloves and got out of there still cursing but silently. It had been a long while since I had gotten stuck by a contaminated needle, but it certainly wasn't the first time. That sort of thing is an occupational hazard for a lab tech, and a very dangerous one in this day of AIDS and Hepatitis C and all the other deadly diseases, but I'm a fatalist; I figured if I had caught anything, filling out an incident form wasn't going to make it go away. Later on I could run some tests on myself and see whether I had lucked out again-or hit the bad end of the jackpot.
• • •
Back in the lab, I set up the runs for a blood count and a chemistry panel on the patient with two of the tubes of blood, dropped one in a rack to begin cross-matching some blood for him and set the last one, the spare, in a rack in the back of the big refrigerator. The panel would take a while, but the blood count was finished in only a minute or two, a far cry from the old days when I was a youngster. Back then instruments were already in labs that did the numerical count of red and white blood cells, but the techs had to stain a slide and examine it under a high power microscope to differentiate the white blood cells into separate categories that told the doctor whether and what type of disease might be present. That was hardly ever done these days except when the instrument gave odd results. Like right then.
The blood analyzer dinged and flashed a light at me while it printed out the results. Not to get technical, but the counts were all screwed up, red and white blood cells alike. None of it made sense to the electronic sensors. The results didn't make sense to me, either.
Either a cold agglutinin or advanced leukemia of some sort was my first thought. I glanced at my watch. It was almost time for the morning shift to begin showing up, but I still had time to make a slide and take a gander at what the blood looked like to the human eye. I began the preparations and that's when all the weirdness started.
Copyright © 2005 Darrell Bain
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