Saturday, July 13, 2013
Boyd's MegaRant Concerning Healthcare Reform - Part 1
How many carts does one department need? I walked into our parts room one day to retrieve our magnificient, 24v Craftsman, cordless drill with the laser sight and "work piece" LED lighting system, and chuckless auto-power bit grip (this will show up again on my list later, and began the long and tedious process of moving various odd carts, portable storage bins, and hydraulic lifts out of the way to get to the back corner wherein our most glorious drill is propped, prominently, on the gray painted altar we fashioned for her and realized that, these carts, storage bins, and hydraulic lifts are always right there, impeding the fulfillment of my immediate need for the exalted drill. I mean, how many carts do we really need? I ventured a thought, which died a quick death, like so many clay pigeons at a skeet range. I thought, perhaps, that these carts and things were always here because my coworkers put them back here after they are used. But, knowing Clinical Engineers the way I do, I realized that they NEVER put tools back where they got them after they are done with the job. Here is the sad, sad truth. A cart is made to have wheels. A cart without wheels is generally referred to as a...wait for it...a table. So, a cart still possessing its natural gift of wheels, that never moves, is being prevented from fulfilling its destiny. The cart, in effect, is performing the job of a table. And like 90% of Americans, according to Max Lucado, the cart, possessive of its wheels, is in the wrong job; as many of us, possessing certain talents, skills, and dreams, are disappointingly so, in the wrong job.
I had to clean water-boogers out of an incubator in the Lab one day. Let me explain. The Blood Bank freezes platelets collected during blood drives and such, for use in patient care. The platelets are frozen to extend their life to keep them viable for use in the human body. There are many uses for this portion of our blood, too many to mention here. Now, in the old days, Pre Y2K, platelets, prior to being used in the human body, were removed from the freezer and placed on a table (without wheels) upon a bed of paper towels to thaw to room temperature which, in a hospital, is usually kept at right around 73 degrees F. When they reached room temperature, measured by seeing that the bag is completely thawed, they were delivered to the unit performing the infusion therapy, where the bag is placed into what is called a blood warmer, a calibrated machine which heats the contents to body temperature, a precise 98.6 F. This process was effective for decades. This process had few fail points. Paper towels don't fail. Room temperature doesn't fail and unless room temperature gets above our body's natural temperature, it never will. But if it does, the last thing on the lab tech's mind will be the platelets on his counter. He'll most likely ignore the rapidly thawing bags and be on the phone calling the facility maintenance department to fix the air-conditioning. Alas, as my good friend and coworker says, "Progress has gone on for far too long." Now we have incubators for platelets. Bags are placed in an insulated box, equipped with heaters and airconditioners to "regulate" the thawing process. Thawing too fast? Turn on the air. Thawing too slow? Turn on the heat. Sounds great right? But wait, there's more. The incubator has temperature monitors that send electrical signals to a box inside the incubator which translate those signals into binary information a computer can understand. Why? Because there is a computer sitting next to the incubators - a $2600 medical grade computer, which takes the binary code, inserts into special proprietary software to graph the thawing process, write reports, and send the reports through the hospital network to the Technical Chief sitting in his office, the insurmountable distance of 10 feet away from the incubator. Additionally, because the thawing process is made more linear by agitating the platelets, an optional "shaker" cabinet can be purchased, and was in this case, which sits inside the incubator and gently, at the soothing rate of 60 oscillations per minute, shakes the bags back and forth. Of course, the computer controls this rate of shake, based on the thawing curve, speeding it up if the linearity gets out of whack, slowing it down too, of course. This shaker, in order to operate, has a CAT-5 network cable connected to a network port, which then links, as well, to this computer. All of this technology, and I had to clean water-boogers out of the incubators drain. Because it is equipped with A/C, there is an evaporator installed as well, outside the incubator, crudely bolted onto the back. When condensation collects, the water fills a pan inside the incubator and is supposed to drain to the outside and fill the evaporator. When this process occurs, the computer, you may have guessed it, signals the evaporator to turn on. It sounds fancier than it really is. The evaporator is a box, open on the top, in which resides a heater coil, that boils the water so it, well, evaporates. Remember the old way I described? Condensation would also occur with the room temperature method of thawing platelets, which was remedied, not by a computer, and miles of network cabling, but by simply taking one of those paper towels and wiping off the bag. With this new-fangled technology, the water tends to grow algae - water, heat, closed places, trays open to heated air, and city water tends to grow things I call water boogers. I have to clean these growths out of these drains twice a year on both machines to keep the evaporated pans from over flowing into the incubator's electronics cabinet which is conveniently located in the bottom of the incubator. To make matters worse, the lab is so congested with technology like our incubator and many other things too wonderful to tell, I have to go to my parts room to retrieve the hydraulic lift cart (a cart with wheels and a hydraulic cylinder used to lift the deck of the cart to counter-top level so I don't have to lift a heavy instrument, I can just slide it onto the cart) to remove the incubator from the lab, and roll it 1.2 miles down hallways which make up this little city that is our hospital, to our shop and my workbench. The resident engineer who clocks in at 7:30 AM, assumes his position at his bench closest to the front door, legs extended, leaning back in his chair, both arms raised and resting, criss-crossed upon his head shouts - it seems this is his function - "Whatcha gonna work on Boyd?"
"A $25,856 paper towel," I grumble.
The 5ft Tape Measure was broken. To make an accurate x-ray, to eliminate any magnification of the image, the distance between the source of the xray and the film must be maintained at an optimal 40 inches. This is called the Source to Image Distance (SID). In the old days, x-ray machines had a built in measuring tape that the technologist, once the patient was positioned on the table, would draw down the tape while adjusting the tube, as read on this measuring device, to the required distance. Then, technology took a step in the right direction - that is, technology attempted to become more precise while eliminating the possibility of human error - by installing detents in the tube crane that snapped the tube at 40" from the film with an audible click and electric brake. The technologist no longer had to worry about getting the SID to exactly 40". Starting, perhaps, right after Y2K, technology made a wild leap forward (?) and here is what happened. The xray machine we needed to fix had a tape measure mounted to the side of the tube assembly to measure the SID. The tape, after many uses, snapped in two. A Clinical Engineer working at the hospital placed an order for a new tape measure from the manufacturer, thinking this was a special tape measure as there were no markings to indicate that it was an off the shelf brand. The company informed the engineer that the SID Calibration Assembly (tape measure) would cost $753.12. After the engineer said a few choice words to the manufacturer he decided to disassemble the xray tube house to see if he could identify this measuring tape and find it somewhere else. When he got it off the machine he turned it over and saw the word STANLEY in its familiar black and yellow logo on the side - the side that was hidden during mounting. The engineer went to Home Depot to find a new one, found the same model and length, and bought it for $4.98. Problem solved right? Not so fast my friends. The manufacturer had machined little rectangular holes along the length of their STANLEY tape measure and installed sensors to count how many holes passed by, and then using a computer to calculate the distance, a signal would be sent to the tube crane to turn on the brake. Understand that these holes were punched into the tape, obliterating the markings one finds on a normal tape measure. For this advancement in "technology" your health care plan deductible barely pays for this one part.