Expressive 2010 2nd Place
Professor: Bryce Christensen
Humanity has much to learn regarding biology and the physical limits of human life. How is it that medical science can keep the tiniest of pre-term babies alive and thriving, yet is unable to revive and save a young victim of a tragic accident? Science has made great strides in the art of temporarily replacing functions that are vital to the preterm infant, even creating an artificial womb of sorts. Yet bodily damage resulting from an automobile accident is irreparable. As complicated riddles are solved on a daily basis, many questions remain unanswered.
My career as a medical professional spans more than twenty years. At one point in time, I pursued the specialty of Newborn Intensive Care nursing. I was a premature infant myself, and four of my own children were lost to miscarriage. I knew I wanted to be a piece of the puzzle that is newborn life. This wish was solidified one evening as I worked my shift in the laboratory at Memorial Hospital in Colorado Springs. A young woman brought a carefully wrapped bundle to our Receiving window. It turned out to be the tiny body of the infant she had miscarried only hours before. In the lab it was our job to assist, at her doctor’s request, in defining the cause of her baby’s untimely death. Unfortunately, it was not the first time this had happened to her.
I worked in the capacity of phlebotomist and lab assistant at the time. For the uninitiated in medical terminology, phleb- is Latin for “vein,” and -otomy means “to remove from.” Patients were never happy to see me and my tray walk into their room. The tray carried lots of sharp things and glass tubes, which translated to an unpleasant procedure. Children, in particular, dreaded my appearance. Though I wore smiley pins and stickers on the front of my lab coat, I was not a welcome addition to a patient’s room. I went on rounds every hour, so I saw a lot of scared people on a frequent basis.
While there is only a minimal amount of science to actually drawing blood, considerably more is involved with processing the specimens. When blood was received in the lab, it was also part of my job to spin the tubes in a centrifuge to separate the plasma from the red cells. There is a wait time involved, and specimen tubes have a variety of additives to consider as well. If not properly processed, blood specimens must be redrawn and reprocessed. If my job is done correctly, the physicians and nurses have answers and can proceed with treatment in an educated manner. The laboratory is capable of delivering results that are life-changing. From this end of the process, nothing seems incurable.
Laboratory machines cannot replace the human touch. Extra care must be taken when drawing from some patients. I speak particularly about the tiniest of humans: premature neonates. Only the smallest of samples may be taken from these tiny beings as they don’t have much blood to begin with. Drops can literally mean the difference in life or death for them. If the sample is not adequate, it will have to be repeated, placing the child in greater danger from a second draw. Even with the utmost in care, other factors (such as dehydration) can alter the blood chemistry enough that, when the sample is spun in the centrifuge, the cells may hemolyze and disintegrate. This, unfortunately, also requires another draw.
With these factors in mind, phlebotomists proceed with caution when entering the Newborn Intensive Care Unit (NICU). I was paged one evening to draw a sample from a tiny three-month premature “crack” baby. When I entered the unit, a nurse led me to the infant, who was fussing and fidgeting from the withdrawal symptoms her mother had inflicted on her. She was a beautiful child, with tiny tight curls on her head, and her skin still held a shade of translucence due to her extreme prematurity. Her hands were smaller than my pinky. The baby’s grandmother was sitting patiently by her side, obviously caring and concerned, and I could see she had been crying. I went to work quickly, advising the woman that her granddaughter was not going to like what I was going to do, but that it was necessary. She only smiled and nodded. I found a surprisingly good vein in the child’s antecubital region, and having already calculated exactly the amount I would need, proceeded to withdraw the blood. I was very conscious of the NICU nurse standing behind me, literally counting the drops as they came out through the butterfly tube. She, too, knew how much was needed, and was there to make sure I took no more than that. Thankfully, the baby had nodded off to sleep as I began and did not reawake before I finished. I returned to the lab and began spinning her bullet-tube sample, which I then handed off to the medical technologist who would finish the testing procedure.
In the process of phlebotomy, the sample must travel from the vein into a needle, pulled by the pressure of a vacutainer tube. If it is not done correctly, the blood cells will lyse, or break up. If drawn and processed correctly, the building blocks of life are visible when viewed under a microscope. There are several different types of cells in the blood alone, not to mention the many other kinds in the human body. Blood cells transport oxygen and nutrients, as well as carry away waste. Their shape and condition inform doctors about a patient’s health and bodily processes.
With the abilities medical science has to intervene in so many ways for good, why is it that the art so often falls short of saving a life? I was made to ponder this issue a little later that same evening, when I was called to visit the Pediatric Intensive Care Unit (PICU). This was on the saddest of missions: a draw on a brain-dead toddler. I had been told the story before I went up, as it was necessary to know how to deal with the family on this issue. The little girl had drowned in a mop bucket that had not been emptied. Her parents were occupied watching the Super Bowl and were honestly unaware of their daughter’s predicament. She had apparently bent over the bucket from curiosity and fallen forward where she had become wedged and drowned. By the time she was discovered, it was too late, and paramedics could not revive her. At the hospital she was treated and placed on life support but did not recover consciousness. Five days had passed and the grieving family had made the decision to offer her organs for donation. Small patients were already waiting in other states for the life her death would provide. As I drew her that night, I could not help but ask God why, with all the knowledge physicians possess and all that can now be done for tiny preemies in the NICU, could we not do something to revive this lovely child? We can remove her organs and place them in another, and that other person will live. Yet she cannot be saved.
One small but significant miracle of medical science is the PKU (phenylketonuria) test for newborns. Phenylketonuria is a severe inherited metabolic condition which, left undiagnosed or untreated, will cause severe seizures, mental retardation, and possibly death. This disorder can be detected in a simple blood test done with a heel prick on a neonate within days of birth. Because of the many lives saved due to this screening, there are now many more conditions included in this first basic blood test. Yet, as I have found personally, many parents choose to remain ignorant of the consequences if the test is not done, claiming it is “barbaric “and “uncivilized” to stick a baby’s heel so “inhumanely.” The parents are provided with literature explaining the life-saving diagnoses that can be identified from this simple procedure, yet many will not consent to the test until they are informed that it is a state law and can be done without their approval. I have been called many unsavory names for performing this procedure on an infant while their protesting parents stand by and watch. Many forms of misery and ill-health can be alleviated by a simple test on a few drops of blood.
While science is miraculous in many instances, it is composed of finite limits. Medical knowledge has been allowed to progress only so far and only so fast. Many preterm babies, born with life-threatening physical problems, can be treated and do survive and thrive. Some full-term babies die shortly before birth for reasons that are never understood. Still more infants die prematurely inside the womb of mysterious causes. While I have had opportunities to personally observe both disasters and miracles, I am still awestruck with the event that is life, and the great strides the medical community has made to physically understand it. While many questions remain unanswered at this point in time, it is encouraging to attempt to comprehend how far mankind has come in attempts to solve the riddles of life and death and to ponder how each answer brings more questions.