Wednesday, May 7, 2008

I fought the lab and ... hey I won this time

One of my favourite tasks as an intern was acting as the after hours (and frequently during hours) blood collection service. Right up there with IVs and manual disempactions.

We all remember being called to draw blood from a patient. The patient was either:

1. A little old lady covered in bruises on all four limbs from IV and blood collections.
2. A heavy smoker with no veins.
3. A child on chemo with a severe needle phobia.

So after multiple stabs and tears you would fill the multiple different coloured tubes that the nurse handed you. An hour later you would be paged back to the same patient to draw more blood because:

1. There wasn't enough blood in the tube
2. There was too much blood in the tube
3. You collected blood in the wrong coloured tube (I used to fill one of each colour just in case)
4. The specimen was not properly labelled
5. The sample was "hemolyzed".

Of course it is over 25 years since I was an intern so I should have gotten over it by now. I still of course collect blood from patients under anaesthesia, and very rarely get called to the floor because no-one else can get blood. I also collect blood from nurses who got a needle stick which brings me to my story.

Now for several years I have resolved to wear gloves when starting IVs but this year I actually started doing so. The other day I went to start on IV on my first patient of the day. He was a little difficult and I had to try a second time but I got the second IV in. I am not the neatest person but I do make a point of being responsible for my own sharps. I picked up the two IV needles with me gloved hand and walked back towards my sharps container. That was when I felt a little prick (not the surgeon) and when I took off my glove I could see a little break in the skin.

Oh shit.

The patient had no obvious risk factors and no visible tattoos. Nevertheless I felt that I should draw blood from him and myself. At our hospital we have a needlestick protocol. You get a ziplocked bag with two tubes, one for the patient and one for you. There are two reqs one for the patient and one for you. You put everything in the same bag and it goes off to staff health.

The patient was still under some I drew some blood from a vein and put it into one of the tubes which I labelled with a sticker. I put his sticker on the req. Finding somebody to draw blood from me was harder. The OR nurses didn't want to do it. Recovery room nurses are good at drawing blood but the req had written across it in handwriting "please do not ask recovery room to draw blood". I finally found another anesthetist between cases. I labelled the tube with my name, filled out the req including my name, my date of birth and my healthcare number. Everything, mine and patient's blood went into the ziplock bag and off to staff health. Now as I was labelling my tube, I thought back to those happy times as an intern acting as the afterhours blood collection and recollection service.

Not much to my surprise, I got a call from the staff health nurse about 30 minutes later stating that the lab would not process my sample because it was not labelled properly. I suggested maybe she should call the lab and straighten things out with them as there were only two samples in a zip-locked bag and one was labelled with the patient's label, the other one had my name it. She asked if I was concerned about the patient's risk factors. I asked if she had never heard of universal precautions?

Now I could have just found somebody to draw another sample, but hey it's my blood, my integrity was violated to get the sample, they should process it. So I phoned the lab director who actually had heard about the fuss already. He said he would bring the sample to the OR and I could label it properly. About five minutes later he phoned back saying that the lab tech had told him, there was no way even if it was relabelled that they would process it.

I asked him, "Are you a physician?" He said "yes". I asked "and you have done a pathology residency?" Yes again. So says I. You have over ten years of post high school training and you are letting someone who graduated from a two year technical school telling you what you can do.

One hour later, he brought the tube to the OR and we relabled it.
Score: Lab 217 BH 1. But at least I'm on the board.

And by the way the patient was negative.

Sunday, May 4, 2008

Hating the Habs

For me, after last night I can again enjoy the NHL Playoffs.

I am one of the millions of people across Canada who hate the Montreal Canadiens. I have nothing against Montreal, I love visiting there and Montreal Smoked Meat is one of the foods I live for. I have nothing against French people (Montreal actually has very few French players anymore).

Every year I live in dread of another Stanley Cup for Montreal (which has happened 12 times in my life).

My obsession is deep seated.

I grew up in a Habs household. Except when I was six, my older brother told me I wasn't allowed to hope for Montreal because that would be copying him. In a Habs household, hoping for the Leafs was out so I hoped for Chicago first because they had (and still have) the coolest logo in the NHL. Later when the Bruins started making the playoffs I cheered for the Bruins (and still cheer for them, except when they play Edmonton).

Off course being a Bruins fan, I have a lot to hate Montreal for. I like to think my hatred is justified on a wider basis as a hockey fan.

There are a number of legitimate beefs.

1. The arrogance.

After expansion, the Habs became a lot like Central Red Army. Most of the good players were concentrated on the Habs supported by some very good role players. It is well known how this came to be.

When the NHL expanded in 1967, the play was that every team would only be able to protect 6 players. This would have allowed expansion teams to draft second and third line players, in other words genuine NHLers. At the last minute Sam Pollock the Habs' GM pursuaded the other GMs that more players should be protected. So teams were able to protect 10 players (in addition to protecting another player for each player drafted). This meant the expansion teams were left with a few third line players, some fourth liners (at that time most teams only used three lines) and minor leagers.

Faced with a team with limitted talent, expansion GMs were now faced with trying to build a competitive team which would attract fans in cities like Oakland and St. Louis with limited hockey experience. Fortunately Sam Pollock was able to come to their aid. Sammie was happy to trade them over the hill players and minor leaguers for draft choices in the new amateur draft (Montreal also got to pick the first two players from Quebec as well). Montreal also was happy to trade players to the expansion teams who happily traded them back when Montreal needed them again. Usually a draft choice changed hands as well. Montreal even traded players to enable to teams to finish ahead of teams whose first round pick they had. On one occasion they traded a draft choice to prevent Boston from drafting a goalie (John Davidson).

The result was that Montreal in addition to winning the Stanley Cup almost every year got 4 first round draft choices. Some of these like Guy Lafleur, Steve Shutt adn Bob Gainey blossomed into stars. Worse were the first rounders who couldn't crack the Habs' line-up who ended up in the press box or the minors. This is at the time when there were at least 4 abysmally bad teams who could have used an NHL grade player. This is not to mention, the career damage to players who could have stepped into the NHL but instead spent 2+ years in the minors.

2. Habs fans.
These people are unfortunately the least knowledgeable and most obnoxious fans. I went to a Habs -Oilers game with my cousin who is a nice guy except when you let him dress up in a Habs jersey and take him to a hockey game. He complained bitterly over every call even the offsides.

Of course most people develop their hockey allegience as children when they first watch hockey. Of course for anybody who started watching hockey in the 60s or 70s, the Habs won just about every year. Now how much of a challenge is it to hope for a team that wins most of its games as well as the Stanley Cup.

The only bright side is that Leafs fans are almost as bad.

3. Refereeing

At the start of every Coach's Corner we get to see a very old clip of a much younger Don Cherry standing on the bench facing the crowd with his arms outstretched. The significance of that clip has been forgotten. Not by my however. Cherry was interviewed before Game 5 of the 1979 series with Montreal, tied 2-2 and predicted that the Bruins could not get a fairly officiated game in Montreal. This clip was taken after Boston's 4th minor penalty in the first period. Needless to say Montreal won the game.

We all remember Montreal players skating through centre ice, no player within 10 feet of him when suddenly his legs would go up in the air, the crowd would roar and the referee's arm would go up. Steve Shutt was a master of this.

Pat Burns after he left the Habs for the Leafs, commented after a Leaf's game, that the refereeing wasn't what he was accustomed to in Montreal.

4. Danny Gallivan / Dick Irvin

It was bad enough in the 70s having to watch Montreal just about every Saturday night (of course the option was Toronto or Vancouver) without having to put up with this dynamic duo. Danny's broadcast was more of a group fellating of the the Canadiens organization than a objective broadcast. Add to that Dick's nasal colour commentary and you wished the mute button had been invented. Back when Vancouver would play Montreal in Montreal, most of us turned the volume on our TVs (a primitive mute button) off and put on the Vancouver radio broadcast. When the Oilers and Flames joined the league which meant you hardly ever got Montreal home games on Saturday night, most of us in Western Canada kissed our TVs in relief.

5. Scotty Bowman

Scotty Bowman is a better than average coach. I give him this.

His main genius however is selecting which team to coach rather than any particular knowledge of hockey.

His record:

St. Louis Blues. Finished first in division and played in Stanley Cup Final (record 0-12) in bizzarre set-up where all 6 expansion teams played in the same division.

Montreal Canadiens. 1971-2 Took over team that had just won Stanley Cup. Finished in 3rd place and eliminated in the first round. 1972-3 Won Stanley Cup next year only because Bruins were decimated by defection to WHA. 1973-4 without Ken Dryden finished second, lost in first round. 1974-5 with Ken Dryden lost in second round.
1975-9 with team that had the advantage of having 4 first round picks for the preceding 4-5 years won 4 straight Stanley Cups. (Harry Neale could have won at least 3 with that line-up). Even the Canadiens are so unimpressed with Bowman that they chose Irving Grundman over him to succeed Sam Pollock.

Moves to Buffalo as coach-GM. Takes team that was a guaranteed dynasty to a series of early playoff exits.

Pittsburg. Takes over Stanley Cup champions after Coach Bob Johnson dies and wins one and only one more Stanley Cup.

Detroit. Joins team as coach AFTER team had already been assembled taking advantage of the NHLs ridiculous free agency rules and with a payroll double some teams. Wins a few but surprisingly not that many Stanley Cups.

Bowman's chief talent aside from chosing which team to coach was his mastery of the referees. This included inviting referees to a video session showing the penalties they should have called against Boston in the previous game (imagine any profesional league in the world allowing this) and as coach of Buffalo getting the NHL to suspend Tiger Williams for alledged slashing Bowman even though nobody saw it and it was not shown on any video replays of the game. I also remember his whine after Buffalo tied the game on a powerplay goal (and won in OT) that that the referee had promised him he would not call any penalties in centre ice.