ASCLS Today Volume 34, Number 7

Beth Warning, MS, MLS(ASCP)^CM, AHI, ASCLS Region IV Director

Meighan Sharp, MLS(ASCP)^CM, ASCLS-Michigan Government Affairs Committee Co-chair

Most often we hear about resistance to change, where people fear it, run from it, and drag their heels to avoid it. We fear the loss of control over what we know and are comfortable with. We fear the unknown and what change will bring. We think change may bring more work, or make us feel stupid, or make us appear inept. For many of us, if it ain’t broke, we ain’t gonna change things.

But now, there are new terms for change, words that are part of our everyday vocabulary indicating what the global pandemic has brought—adapted, converted, pivoted, shifted, modified—all because of the “unprecedented disruption” and “sudden interruption.” Never before has there been such a time of urgent, critical change for members of the medical laboratory community where we have rapidly changed and then changed again. And as the winds of change swirl around us, we choose to show our “grit.”

“Having a passion and sustained persistence—what better words to describe the laboratory professional in the whirlwind we call the novel coronavirus pandemic!”

Angela Duckworth, a professor of psychology at the University of Pennsylvania and expert on grit, defines it as a person having a passion and sustained persistence. Having a passion and sustained persistence—what better words to describe the laboratory professional in the whirlwind we call the novel coronavirus pandemic! While Duckworth has spent years studying situational effects to bring about this resiliency, grit has been demonstrated daily on the frontlines of the laboratory as we face a global pandemic head on.

From those in institutions of higher education, we had literally days to devise a plan to deliver lectures in an online synchronous or asynchronous fashion, along with making provisions for virtual online lab sessions during the spring term (which has now carried through into the teaching strategies for summer and fall and …). Clinical rotations were delayed, shortened, or even omitted, as clinical placements were no longer an option with our usual affiliates. The strong online cohort of educators rallied via social media and through online communities to share ideas and best practices, knowing that we are all in this together. We sacrificed our stockpiles of PPE to those on the frontline, as there was no longer a need for gloves and masks when providing YouTube videos and paper problems in place of face-to-face lab sessions.

Laboratory directors suddenly became supply chain managers, scavenging for PPE to protect their “work families,” now frontline staff. Pandemic plans were written and rewritten. Scheduling was complicated, creating “bubbles” and “work groups,” shifting those on normally high-volume benches to become COVID processors, accessioning samples, or collection kit assemblers, having the right people at the right time.

Many of us are still moving headfirst into the wind, putting one foot in front of the other. Some days we stride two steps forward; other days we lose ground and take two steps backward. If there is one thing to take note of, it is that we, as a profession, have stepped up to the challenge, because we are resilient.

To highlight just how gritty we are here in Region IV, Meighan Sharp, of ASCLS-Michigan, shares the passion and persistence of McLaren Port Huron. We are all in this together. Resilience, grit, passion, persistence: laboratory professional.

Beth Warning is Assistant Professor in the Medical Laboratory Science Program at the University of Cincinnati-College of Allied Health Sciences.

From left: Cindy Sliwinski, MT(ASCP); Meighan Sharp, MLS(ASCP)CM; Chelsea Khabbaz, MLS(ASCP)CM; Kara Kaufman, MLS(ASCP)CM; and Debbie Isenhart, MT(ASCP), at McLaren Port Huron.

From left: Shirley Schemanske, Jillian Frank, and Tracy Gracey, phlebotomists at McLaren Port Huron.

Meighan’s Story

I work as a generalist at McLaren Port Huron (MPH) in Port Huron, Michigan. MPH is part of the McLaren Health System with nearly 20 hospitals and clinics across the state of Michigan. McLaren recently branched out into Ohio with the acquisition of St. Luke’s Hospital in Maumee.

In the first few months of the pandemic our hospital was hurting. Gretchen Whitmer, governor of Michigan, banned elective hospital services and surgeries throughout the state to help conserve stores of PPE. Our outpatient laboratory closed from March to June. Our affiliate clinics and doctors’ offices closed their doors moving toward telehealth appointments. Phlebotomists, lab support staff, and some IT staff were furloughed due to the dramatic decrease in patient specimen processing. Techs were asked to take “low census” days off to keep staffing at a minimum. Our blood bank was hurting as well. Blood supplies were at a critically low volume. Our blood supplier, American Red Cross Southeast Michigan Region, was not getting its supply due to local blood drives being canceled. Their distribution center had to close its doors altogether for a while due to a spike in COVID-19 cases among their employees. We had to rely on getting blood from Lansing, which was double the drive time for couriers.

McLaren was no stranger to stepping up when it came to COVID testing. McLaren uses a centralized laboratory model. All McLaren affiliate hospitals send a certain percentage of their laboratory work to McLaren Medical Laboratories in Flint. That included our COVID testing. Port Huron had the capability of bringing the rapid Abbott Alere COVID test on board. We were able to use this platform for patients needing emergency surgery and for inpatients needing to be discharged to long-term care facilities. All other COVID tests were sent to our Flint Lab where multiple platforms (Roche and Cepheid) were validated to handle the influx of specimens. Our turnaround times have improved from 48 hours in March and April to 12-24 hours today.

Today, we are busier than ever. Employees have been called back to work, surgeries are being performed, elective procedures are being scheduled and performed, and our outpatient lab is open once again to service our community. Our outpatient lab performs drive through swab collection for COVID testing (must have physician’s order). Our supply of PPE is good, too. McLaren has partnered with companies across the state to ensure we have an ample supply of gowns, gloves, masks, and shields. We are still running into other supply chain issues, however, as the Flint Laboratory still has Roche sample tips on backorder and Port Huron Lab has backorders on supplies like specimen caps, sample tips used for routine testing, and test tubes. MPH is currently completely out of Alere supplies for COVID testing with no date as to when an order will be fulfilled.

As ASCLS-Michigan’s co-chair for the Government Affairs Committee, I have been in contact periodically with our members of Congress and the Senate. They are always interested in hearing our stories and concerns. I have also begun reaching out to candidates running for seats in Congress to get their take and to educate them on the laboratory profession’s impact on the pandemic. I recently reached out to the Michigan House Appropriations Committee to express my disappointment on the distribution of CARES Act (Coronavirus Aid, Relief, and Economic Security) money for hazard pay use.

When I heard that CARES Act money was to be distributed to frontline healthcare workers as hazard pay, I was hopeful, but skeptical. I was right to be skeptical. After seeing the language of the bill that went to the governor’s desk, I saw that hazard pay was only being given to nurses, nursing aides, and respiratory therapists. I wrote a letter to members of the Appropriations Committee expressing my disappointment about this decision. I emphasized the role laboratory professionals have played during this pandemic and our importance to the health and safety to all Michiganders. I was able to get a response from Appropriations Committee Chair Shane Hernandez. He expressed his gratitude to all of us and the role we have played in this pandemic. He thanked me on educating him on the role that laboratory professionals play in healthcare. He also said there was only so much money to work with and they had to be extremely selective as to who would get hazard pay.

I continue to reach out to government officials both at the state and national level. I continue to go into work every day and give 110 percent to patients and coworkers. We have come back stronger and busier than ever. I have a great group of coworkers. We all have a great work ethic and rely on each other to release quality lab results every day.

Meighan Sharp is a generalist at McLaren Port Huron in Port Huron, Michigan.

Laboratory students are facing new issues due to COVID-19, like the transition to online classes, delayed or shortened clinical rotations, and limited access to certification exams. Despite general feelings of uncertainty, many have shown considerable resilience and made the most of their situations. Below, each of the new Developing Professionals Forum officers share their personal stories through the lens of a pandemic.

Kate Hadlich, Developing Professionals Forum Chair

As I reflect on the ways COVID-19 has impacted me personally, I am also reminded of the ways it has helped our profession grow. For example, COVID-19 has presented laboratorians with the momentum and platform from which we can educate the public about our important role on the healthcare team. Additionally, it has created an environment through which we can share our expertise.

Recently, my family and friends have shown an increased interest in what I do and even ask me about things they see in the news or on social media, like vaccines, herd immunity, and antibodies. The ASCLS Code of Ethics states, “As practitioners of an autonomous profession, Medical Laboratory Professionals have the responsibility to contribute from their sphere of professional competence to the general wellbeing of society.” COVID-19 is an excellent opportunity for us to share our knowledge—with family, friends, the media, and legislators.

The ASCLS Code of Ethics also states, “Medical Laboratory Professionals work with all patients and all patient samples without regard to disease state, ethnicity, race, religion, or sexual orientation.” I think the saying, “the patient comes first,” nicely summarizes this quote. In the face of a pandemic, medical laboratory professionals have conquered their personal fears and stepped up to the challenge. They continue to test all patient samples, including those from COVID-19 positive patients. During my clinical rotations at Promedica in Toledo, Ohio, I realized how easy it is to forget that each sample belongs to a person, but I also learned to recognize the enormous impact that a test result, like COVID-19, can have on that person’s life.

Find Kate on ASCLS Connect.

Sara Oswald, Developing Professionals Forum Vice Chair

Being a laboratory student during the challenging times in which we live has turned out to be an invaluable experience. Certainly there have been some aspects that haven’t been ideal, such as having to undergo COVID testing before I could be allowed on campus, missing out on valuable clinical hours when I was required to self-isolate after I developed a non-COVID-related illness, and not knowing what any of my new instructors and mentors actually look like below the eyes. Ultimately, however, I feel privileged to be allowed a front-row seat watching history be made on the frontlines of the epidemic by everyday laboratorians.

I am currently in my blood bank clinical rotation at St. Mary’s Hospital in Grand Junction, Colorado, which supplies many of the blood products for the Western Slope of Colorado, as well as Eastern Utah. It has been an exciting whirlwind of new information and experiences, and in the midst of them, I have been able to witness how convalescent plasma is being collected and used both therapeutically and for continuing SARS-CoV-2 research. I have also been able to see the implementation of exciting new community screening methods, such as the RT-LAMP saliva assay. And I have been able to witness the robust nature of the scientific community as we continue to study and scrutinize test methodologies approved under Emergency Use Authorizations (EUA), resulting in some of those EUAs being withdrawn. This is not an easy time to be a student. But there has never been a better time to learn.

Find Sara on ASCLS Connect.

Heather Herrington, Developing Professionals Forum Secretary

Two years ago, I applied to the post baccalaureate MLS certificate program at George Washington University. Never in a million years would I have anticipated wrapping up my clinical rotations during a global pandemic. While I wish we were all living in less interesting times, this situation has vividly illustrated how those in the medical laboratory community can switch gears and make valuable contributions.

I have done my rotations at the University of Pittsburgh Medical Center (UPMC) and Vitalant in Pittsburgh. When I was in the Chemistry Department at UPMC, I spent some time in the Serology Lab, which had asked its employees for volunteers to both run the test for SARS-CoV-2 and help with various research projects. One of the laboratory professionals noticed a pattern with some of the data and was able to suggest that a medical resident investigate further, potentially as a postdoctoral project. Prior to that experience, it had never even occurred to me that we, as laboratorians, could contribute to medical research by helping to determine what should be studied. We are truly an integral part of the healthcare team, and our role is even bigger than what I had previously considered.

Find Heather on ASCLS Connect.

The Developing Professionals Forum is open to all ASCLS Developing Professional (student) members. Learn more.

Audrey Folsom, DHSc, MSHS, MT(ASCP)

Photo credit: Abdrahim Oulfakir, Unsplash

Stress is an inevitable part of life. Some stresses are desirable, such as the birth of a child; some are undesirable, such as the loss of a loved one. Situations such as the novel coronavirus pandemic increase stress and anxiety due to the uncertainty it creates. When faced with uncertainty, our default reaction is to experience fear and anxiety, and turn on the “fight, flight, or freeze” response, which causes the brain to turn to the amygdala for decision making. This makes us more reactive and causes us to behave poorly or make unwise decisions. The amygdala is a preverbal part of the brain, which is why it is impossible to tell yourself to relax and actually make it happen. The stressed part of your brain cannot understand language. This can make us stuck in the sympathetic part of the nervous system until the threat subsides. (Fletcher, 2019, p. 37)

If language will not work, how does one communicate with the amygdala and turn off this sympathetic “fight or flight” response? The answer is rather simple: turn on a parasympathetic response. The parasympathetic nervous system is the one in charge of digestion, rest, and relaxation. This is why, when stress strikes, it is hard to sleep well, e.g., “tired and wired,” and why many experience digestive issues while under stress. The simplest way to turn on a parasympathetic signal is to double the length of your exhale while breathing. This signals the brain that everything is fine, and you are safe.

“I had more clarity of thought, my occasional brain fog had lifted, and I felt more present in my life and less bothered by annoyances.”

It can be as simple as breathing in for a count of two and breathing out for a count of four, which may be all you can manage if you are really anxious. I have found that any number between two and five can work for the inhale, as long as the exhale is doubled (for example, in for four, out for eight). This can be done with eyes open or closed and should be done for 15 cycles or about three minutes. Then, think of three simple things for which you are grateful. This nails it in because it is impossible to be afraid and grateful at the same time. This can be done anytime it is needed, multiple times a day. (Fletcher, 2019, pp. 37-38)

Meditation has become an invaluable tool in my stress-fighting belt. I ventured into the practice of meditation a couple of years ago. It took me a while to find a meditation practice that I would do for more than a week or two. The first one that stuck was Vishen Lakhiani’s six-phase meditation. Vishen is the author of The Code of the Extraordinary Mind and The Buddha and the Badass and the founder of Mindvalley, an education site with the mission of teaching the world the art of truly living extraordinary, fulfilling, happy lives (Lakhiani, n.d.). A quick search for “6-phase meditation” on YouTube can get you started. He also has a free meditation course on Mindvalley.

I used this technique for more than six months with great results. I had more clarity of thought, my occasional brain fog had lifted, and I felt more present in my life and less bothered by annoyances. I credit this practice with getting me through the process of my doctoral dissertation without suffering a mental breakdown. Then, I ran across the work of one of Vishen’s students, Emily Fletcher, author of Stress Less, Accomplish More, and founder of Ziva Meditation. I read it over Christmas break 2019. In retrospect, it was as if God (or the universe) said, “Read this, you are going to need it shortly!”

Emily’s meditation practice resonated with me more deeply than Vishen’s, but I can also see the similarities between them. In her book, Emily provides the practical tools to upgrade personal and professional performance, no matter who you are. The book version of the meditation technique is called the Z-technique and has become an integral part of my daily routine. It has decreased my stress level, increased my energy, given me deeper and more restorative sleep, increased my creativity and adaptability, and lengthened the time I can spend in focused work.

It only takes 15 minutes, twice a day. And, if you think you don’t have time, try it anyway because you will gain those 30 minutes right back (and more) in increased productivity. If you object on the count that you can’t clear your mind, then the Z-technique is for you because it doesn’t require you to clear your mind. This is because “it is as impossible to will your mind to not think as it is to will your heart to not beat.” (Fletcher, 2019)

If you want to build resilience to stress into your life, I highly encourage you to pick one of the aforementioned books, start a daily meditation practice, and learn simple breathing techniques. These practices will help you shed stress from your past, deal with stress in the present, and visualize goals for your future.

Audrey Folsom is an Assistant Professor, Clinical Laboratory Science, at Arkansas State University in Jonesboro. She can be found on Instagram @audreylovesoilsandscience.

Pat Tille, PhD, MT(ASCP)

It is the middle of August and the weather is in the 80s and 90s. There is a global pandemic, so all your interactions are limited only to those you share your household with or close family, due to assisting with childcare or other needs as you can. Activities outdoors are “safer,” because you can more easily socially distance and have much better circulation. Everyone has been wearing masks when going to places like the store for groceries and not attending any major events or large group gatherings. And then it happens.

You wake up one day and your nose is stuffed up and you have a sore throat. You wait a couple days thinking it is just a short-lived event because you have been going between air-conditioning and heat. Symptoms do not resolve so you visit your family care provider. The provider does an exam, looks in your ears, your nose, your throat and says you clearly have a sinus infection. You ask if you should get tested for COVID-19 and the provider says, nope this is clearly bacterial. The provider prescribes Augmentin and a steroid, which you know from previous experience has the potential to cause serious gastrointestinal (GI) discomfort and diarrhea, but you figure you will try it.

After five days you cannot eat and are struggling to take in enough fluid. You begin to feel weak and light-headed and figure it is time to stop the antibiotic and maybe go in and get some IV fluids to rehydrate you.

In the emergency room (ER), the nurse comes in and checks your vitals. She places a nasal canula on you underneath your mask with two liters of O2 and leaves the room. The ER physician comes in and goes through your signs and symptoms with you and says he wants to do a computed tomography to check your colon, etc., and collect a stool sample for Clostridiodes difficile. In the meantime, you are given a bag of IV fluid, an injection of Zofran to reduce nausea, and a shot of morphine for discomfort. You come back from radiology, and the provider pulls up the digital image from the CT. He says your GI looks great, but it is this in your lungs that is concerning.

Well, being the healthcare professional that you are, and a microbiologist who has been reading and watching the pandemic for many months, he had to say no more. In both of your lungs there are some patchy areas that are quite diffuse and clearly evidence of viral infiltrates. The provider says this is a concern and begins to question you about your breathing. After about two hours from your initial arrival in the ER, the provider realizes you have a nasal canula with O2. He asks when you put that on. You calmly respond that the nurse did it after your initial vitals. The provider says, he thought you were wearing it simply because morphine can cause a drop in your saturation levels, but it returns to normal within a reasonable time. The provider says he is concerned and is thinking of admitting you to the COVID-19 acute care ward. Of course, you have no intention of going there, and ask why. He says, because your oxygen saturation is not staying above 88 percent, even on two liters.

“It has been almost four weeks since I entered the ER with an expectation to receive some IV fluids and be sent home. I am still required to have one liter of oxygen at night while I sleep to prevent my oxygen from dropping.”

The Acute Ward

Well, if you have not been paying attention, going to a COVID-19 acute care ward has not met with very positive news coverage. The stories of lack of personal protective equipment, the crowded halls with equipment and people, and no visitors is enough for you to not ever want to see the inside of one of those wards. Unfortunately, I was headed that way. It took another hour before I was taken from the ER out to the back-ambulance elevator and shuttled in a wheelchair through some back hallways to a set of double doors to the COVID acute care ward.

Upon entering the hall, my worst nightmare became reality. There were carts of equipment lining one side of the hall, from scales to weigh you, to carts of syringes, IV tubing, coban, and every disposal medical supply you can imagine. In addition, there were crash carts, portable oxygen tanks, and computers on carts. I was put in a room that had one small window, reminiscent of a hospital room from the 1980s. There were no modern electronics for patient care, no automatic blood pressure cuff, no pulse oximeter, no modern health-care equipment. Eventually, I was fitted with a portable battery-operated pulse oximeter that the nurses connected via blue tooth to a monitor at the nurse’s station.

Shortly after my arrival, the primary COVID acute care ward physician came in and introduced herself. She looked at my chart and explained how there is no cure for the virus, but they were going to do what they could for me. She said, I will have the nurse bring you some paperwork, so we can begin to treat you and hopefully you will improve.

By now COVID has been around for more than six months, and I had done enough reading that I simply looked at the physician and said, “Hit me with everything you got from Remdesivir to convalescent plasma, because I am going home.” If the trip from the ER to the floor was not depressing enough, the hallway, lack of equipment, and isolation room most certainly would be enough cause for any average person to have high anxiety and potentially a panic attack at this point. The positive part of this whole experience was that the physician had a solid treatment plan that she insured was put into place in less than a few hours following my admission, but that is another long narrative.

It was not more than eight hours, and I could not even walk to the bathroom without my oxygen levels dropping so low that the nurse would come in, and over the first few days, my two liters went up to five liters. It seems from talking to the nurses that I was somewhat unusual; I had no other symptoms that have been associated with COVID other than the diarrhea I had complained about when arriving in the ER.

The Long Road to Recovery

After four days of treatment, physical therapy, occupational therapy, and a sleep study, I was released on day five with an order for oxygen therapy at night to prevent my oxygen saturation from dropping too low. I was also put on a daily home monitoring system and required to log my temperature and oxygen saturation twice daily. I also received daily calls from a nurse to monitor my recovery. I was able to keep my oxygen off during the day, as I was now holding at around 95 percent saturation. But even with that, the smallest amount of activity would cause it to drop rapidly to 91 percent and increase my heart rate at times above 130 beats per minute.

My husband, who was also COVID-19 positive, had only experienced what he described as “hangover like” headaches for a few days while I was hospitalized. Because of his minor symptoms, but requirement to quarantine, he was able to help me around, help me shower, and ensure I was getting three meals a day. For the first week, I was not able to do much—even working on a computer—without the need to take intermittent naps to regain my strength. After that first week, it seemed my fatigue decreased, and I slowly began to be able to manage tasks more on my own.

At the time of writing this article in early September, it has been almost four weeks since I entered the ER with an expectation to receive some IV fluids and be sent home. I am still required to have one liter of oxygen at night while I sleep to prevent my oxygen from dropping. I keep a pulse oximeter near me always and check my oxygen saturation because COVID-19 can cause rapid unexpected drops without any prior symptoms. I still get short of breath, and some of the daily activities can be overwhelming at times. Some days I feel almost normal, and other days it seems like I just need more rest.

It is still early, and despite that I am counted as a “recovery,” since I received clearance from our state public health lab, the word recovery seems so inappropriate at this point. I have no idea how long this road will be or how it will end. During this period, eight out of 16 family members, including myself, had their own experiences with COVID 19—from my one-year-old granddaughter and other grandchildren, to two of my own children, with one also being hospitalized three days after my release, to my sons-in-law, husband and myself, both 61 years old. The COVID-19 story for all of them, is different from my own. When I was released from the hospital my primary provider told me “I was lucky.” I guess time will tell.

Pat Tille is Associate Professor and Graduate Program Director at the University of Cincinnati College of Allied Health Sciences and lives in Sioux Falls, South Dakota.