This is the story of my life as a lab tech, from a boy leaving the farm, to working in a clinical laboratory. I was born in 1933, so I am now 91 years old. I still remember going down the path to the barn that my father built to help milk and take care of the cows and feed the calves, wanting to work instead in a lab. When I was about 14 years old, I saw a doctor who did his own lab work. He showed me the counting chamber with the red and white cells in it that he was counting — I was very fascinated. Right after that, I wanted to do that type of testing, but there was little chance of that happening to me as the lone eighth grade graduate in my class of a small country school.
The family farm
In Oregon at that time, high school was required for all students under 16 years of age, but it was not enforced. So, at 14, I did not go to high school, but continued to assist my family on the farm, which consisted of father, mother, six boys, and four girls. I was number three in the sibling order.
I had already read about all the books in our school library and was starting to go to the Silverton Library for books such as Men Against Death, Microbe Hunters, Hunger Fighters, and almost all of Paul De Kruif’s series of medical books. Also, books on Madame Curie and Charles Lindbergh. I read no novels. I felt they were a waste of time, just made-up stories. My first love was airplanes, but being pragmatic, I could see that working in a lab was going to be more attainable. I was a great fan of Charles Lindbergh and Amelia Earhart. I also read all of Admiral Richard E. Byrd’s books about his polar explorations. But that, I knew, was way beyond my attainment. And anyway, by then exploring was almost over, so it was lab work that held the greatest chance of both exploring and a meaningful occupation. It would also get me off the farm. It was not that I disliked farmwork, but I was excited with the microscopic wonderland, just as Anton van Leeuwenhoek was when he first saw bacteria and called them “wee beasties.”
Our family doctor at that time was a great lover of cream and would come to our farm about weekly to buy cream from our family, and I eventually was able to go to his office in Silverton to assist the lab tech. I was about 17 at the time. After working at home all day, I would go to Silverton in the evening and wash and dry all the glassware that the lab tech Eddie Condon had used.
In the fifties we did not have plastic labware; it was all glass. From the small pipettes for WBC and RBC counts, and the glass pipettes for transferring fluid for chemistries, it was all glass. At that time, it was all mouth pipetting, there were no automated pipettes as today, and even the 20% sodium cyanide that we pipetted, when performing the Uric Acid test was all mouth pipetted. Mr. Condon indicated that if I washed his glassware, he would help me learn to be a lab tech. Of course this was all free for him, as I was not being paid. I soon found that I was being used, as I was not learning that much about testing, but was good at washing glassware for him.
During this time, besides working full time during the day for my father, I was later at night taking a home study high school course from the American School to work toward getting a high school diploma. Besides that, I was also taking a home study course on Clinical Lab Technique by the Imperial Technical Institute in Texas. At about 19 years of age, I saw washing glassware was not getting me ready for a job, so I quit that and concentrated on my home study courses and of course working on the farm full time. So, I was quite busy with all these things and really burned the midnight oil. During this time, I was also helping my father with logging and hauling logs to the local sawmill. We also had 45 acres of hops, which took up a lot of our time in the spring working in the field. Then in the summer and fall, I worked in the hop house (A hop house is a large building where hops are dried, processed, and baled prior to being sold to brewers). The year that I was 20, I worked at the hop house almost around the clock, usually putting in about 20 hours a day and just sleeping on a plank, covered with burlap, for a few hours a night. That year, two of us baled over 700 two-hundred-pound bales of hops, as a two-man crew.
Laboratory student at OTI
During the State Fair that summer, the Oregon Technical Institute in Klamath Falls had a display at the Fair showing some med tech students pipetting and performing lab tests that really got my interest. Here was a school right here in Oregon, but still about 220 miles away from me, where I could go and learn to be a real med tech. I did not let that encounter go to waste. I checked it out and decided that I would go there and take the Medical Laboratory Technique course that fall. This was going to be a change for my family, one less worker at home, but I had four younger brothers and three younger sisters that could help my dad by then.
On a Thursday near the end of September, we picked sweet corn by hand for the cannery, all day. The next morning on a Friday, the last day that a student could still get into the fall classes at Oregon Tech, we got up real early and my folks took me to Klamath Falls and dropped me off at the Registrar’s office. I met with Mr. Smith, the Dean of Students, and presented my qualifications. Of course I did not have a high school diploma, as was required. I knew that that would be a problem, but I came prepared. I had a letter from both my doctor and dentist, saying that I could do the work. He accepted that information and allowed me to start the lab program. Of course, I was starting almost two weeks after classes had already begun, so I was behind the rest of the students, but my advantage was that I already had some experience working in a lab, so I caught up quickly.
That first evening, I already had a part-time job working for the concessions at the football game. I also was able to get a part-time job as a janitor. Our two lab instructors were well informed. One was a retired naval Chief Warrant Officer, who was an MT, RN, and a pharmacist. He was also a parasitologist who previously taught parasitology at the Armed Forces Institute of Pathology. The other instructor had worked with Dr. Rueben Kahn, who developed the first major non-complement fixation test for syphilis, the Kahn test, which was the standard test for syphilis in 1953. At that time, not every lab could perform the complement fixation test or the Kolmer, as they were quite complex, most used the Kahn or later the VDRL.
We practiced drawing blood on each other. That was easy for me as I had already performed many venipunctures in the lab in Silverton. Our textbook was the Fifth Edition of Clinical Laboratory Methods and Diagnosis written by R.B.H. Gradwohl, M.D. D.Sc., an ex-Commander, Medical Corp, of the U.S. Navy. This was a two-volume set of 2,400 pages, and it covered lab testing from A-Z and then some.
Interestingly, the whole campus of the Oregon Technical Institute (OTI) was a self-contained town of Oretech, with its own library, theater, post office, fire department, coal-fired heating plant, gymnasium, cafeteria, barracks for the students and faculty housing. All located a mile high, in a little valley above the city of Klamath Falls. The entire site was purchased from the military by the state of Oregon for 1 dollar in 1946 and revamped into a technical school, starting classes in 1947. It was built by the military, just before the end of World War II, to accommodate the many military personnel returning from the South Pacific who had malaria and filariasis. The military felt these personnel needed to be isolated to prevent the spread of those diseases to the civilian population. The military had a concern that if the military personnel were back in the general population and were bitten by mosquitoes, they could pass on these diseases to the civilians.
It is a fact, that the malaria spreading mosquito, Aedes Aegypti, cannot fly above 5,000 feet, so placing the military recuperation center at a mile high would protect the civilians. It was used only about a year, and then they no longer had any use for it. It even included the largest swimming pool west of the Mississippi. But after the state of Oregon purchased it, they never even filled the swimming pool as it would have been too expensive for the school to pump all that water up the 1,000-foot OTI hill to fill the pool, so it was instead used as a running track.
I completed the two-year Med Lab Tech program in 1955. During my second year there, I was the editor of the school newspaper, The Miler, and I also worked at the local hospital every evening five days a week during the spring term. I performed the tissue technique, sectioning and staining the tissues for the pathologist, as I had already taken Tissue Technique and was able to work before I graduated. For Parasitology, we would collect stool specimens from the students and from local slaughterhouses. From our own students, we found Giardia lamblia, Entamoeba coli, and Endolimax nana. From the animal specimens, we found many Fasciola hepatica, Ascaris lumbricoides, and pork and beef tapeworms. We also microscopically identified many of the worm eggs from the animal stool specimens. The instructor, Mr. Martin, supplemented those specimens with some that Dr. Ernest Carroll Faust sent to him from his Tropical Medicine collection.
We also performed the sodium and potassium analytes using the chemistry method of Kramer and Tisdall, which was a two-day procedure, as most labs at that time did not yet use the flame photometer. So, there was no such thing as stat electrolytes in a lot of labs at that time. We also did thyroid tests with the BMR (basal metabolic rate) instrument, where we would determine the oxygen consumption and from a chart determine whether the person was normal, hypothyroid, or hyperthyroid. We learned to perform ECGs (electrocardiograms) using an instrument invented by Willem Einthoven through a gold-plated quartz string that would capture the shadow of the electrical impulse movement of the quartz string on a roll of photographic paper. This would then be taken to the radiology department, and it would be developed using the tanks that they developed the x-ray film in. Direct writers were probably available by then, but the school could not buy all the latest equipment.
We, at that time, performed all hematology using the small RBC and WBC pipettes. By using diluting fluid and placing the fluid on a hemocytometer, we would visually count the number of red and white cells on separate sides of the chamber and then by calculation come up with the actual blood count. Mr. Wallace Coulter perfected the Coulter Counter in 1948, but it was many years after that before the instrument was available for small labs to use. Our white cell differential counts were also performed visually for many more years after the Coulter Counter came out, as that technology to determine the WBC differential was much more complex.
We also learned how to perform intubations for gastric analysis. At that time, the instructor had us use a plastic tube with an olive-sized metal bulb on the end, which as a weight allowed it to go down easier, and we would pass it through the mouth, not the nose, as we did later. Once when one of the students put it down my mouth and tried to aspirate the gastric fluid, he could not get any. He asked the instructor what was wrong, our instructor put the tube to his ear and said, “you had better take it out of his lungs.” Which he did. Then he put it in again, and he did get gastric fluid, but when he tried to take it out of my stomach, it was stuck. He again asked Mr. Martin what to do. He said that we could cut it off and let it go through, but we would have to pay him for the tube. Or, he suggested, “You can go down to the hospital and have the pathologist take it out.”
I did not want to pay for a new tube. One of the students offered to take me to the pathologist. He had no trouble, and it was a great learning experience for us. He gave me a glass of water, and as I swallowed the water, he quickly pulled it out. As the gastroesophageal sphincter opened to allow the water through, the olive-sized bulb came right up through the sphincter. Then we went back to class, but being a glutton for punishment, the first thing I did was to have someone put the gastric tube in again, and the same thing happened, it was stuck. But now we had learned what to do, I drank a little water, swallowed, and it came right out.
As the radiology students were right next door, we were frequently asked to be their patients, as they needed people to practice on. I did notice that I was able to feel the x-rays. I mentioned that to the radiology instructor, and he did not buy it. He said that we cannot hear, feel, smell, taste, or see x-rays. And he had worked on the Manhattan Project in the 40’s where they developed the atomic bomb, so he was not convinced easily. I was insistent, so he tested me with an x-ray machine, it did not make a sound if I was x-rayed or not. I passed that test, and he was beside himself. Years later, I think I discovered why I was feeling the ionizing rays. When I was in lab school, I always wore an orlon shirt, similar to nylon, and when I would go to radiology, they would have me take it off and put on a gown. What I was feeling was the effect of the ionization of the air, as the rays hit my arm, as I was ionically charged by taking off the orlon shirt. When the x-rays went through me, I was feeling the change of the ionic charge on my arms. This is only my theory; it has not been substantiated by any real research. No, I did not glow in the dark.
The method of performing pregnancy testing in the 50’s was to use a rabbit or frog. A woman, wishing to know if she was pregnant, was to bring in a urine specimen. We would inject, either under the skin or into a vein in the rabbit’s ear, about 5–10 milliliters of urine. After 48 hours, we’d kill the rabbit and observe the ovaries to see if they were hemorrhagic. If they were, we would indicate that the woman’s pregnancy test was positive. When we did this test in class, we had a classmate beg for some urine from a pregnant friend, and we did the test. After 48 hours, we killed the rabbit, opened it up and looked at the ovaries and they were hemorrhagic. That was quite exciting. Then our instructor gave us another project, he told us to take out the lungs and process the lung tissue, and from it, he had us extract thromboplastin. We then processed this further and made our own thromboplastin, standardized it, and were able to perform prothrombin times with it. But that was not the end of the rabbit. I skinned it out, threw away the hide, and saved the meat for my dinner.
Some years later we started performing the pregnancy test using male frogs. We would concentrate the woman’s urine and then inject it into the dorsal lymph sac of the frog. After waiting 3–6 hours, we would bounce the frogs behind on a glass microscopic slide and look for spermatozoa under the microscope. If we found sperm, we would report it as a positive; no sperm, it was a negative result. Using a female frog for the pregnancy test was a similar technique, but the end result was different. If she laid eggs, the woman’s test was positive. I cannot confirm that any of the pregnancy tests were 100% accurate — we did not perform any proficiency testing on the various pregnancy tests.
Near the end of the second year, all the students would spend the last six weeks in a lab residency, where we worked in a real lab and were able to perform testing on patients under supervision. I spent my six-week residency in a large clinic in Bend, Oregon. There I watched the Lab Manager make autogenous vaccines for patients that had allergies. (We did not learn this in lab school.) He had previous experience working with Dr. Reuben Kahn, the one who developed the Kahn test for syphilis. He would have patients bring in things that they may be allergic to, such as cat hair, floor dust, vacuum cleaner contents, what have you, and make an autogenous vaccine from that material. It would be processed into a vaccine, sterilized, diluted, and put in a small vial for the doctor to then use on that patient. No proficiency testing on this concoction either.
First official lab job
Now it was mid-year 1955 and I was out of school and ready to go to work. I decided to try working in Portland, which would also allow me to take night classes at Portland State University. I got a job at a medical clinic with about six doctors, most were internal medicine specialists. There, I performed all the lab work for the doctors. At that lab, I had a lot of patients that I had to do stool exams on, for ova and parasites, as at that time in the mid 50’s, there were a lot of Giardia infections in the population. Some people called it various names: such as Beaver Fever, Montezuma’s Revenge, Traveler’s diarrhea, or just persistent stomachache. There, almost every day first thing in the morning , I would perform a BMR. The patient would be fasting and would come in, in as basal a state as possible, and then rest for a half hour on the cot. I would then come in and do the BMR. It would take about 10 minutes, and I would be measuring their rate of oxygen uptake and from that result, the doctor would determine their thyroid activity. That was the thyroid test that was used at that time. There was no PBI (protein bound iodine), no Thyroxine total, no TSH, no T4, no T3, all those were yet to come. Remember, this was still the dark ages.
Automation was slowly beginning, and some were still boiling urine for the test for protein. We were still cooking sugars with Benedicts Solution, and all mouth pipetting. Yes, I tasted blood more than once, and it was not mine. I also performed a lot of ECGs there, and also the Master’s Two Step, which was a method of putting some stress on the heart and then performing multiple ECGs at different time intervals after the exercise. This was also before the treadmill ECG was used for that purpose.
On every Tuesday evening, I would volunteer for four hours at the Filter Center in Portland. This was a large room in the basement of a building that had a large wooden table that was a map of the Pacific Northwest. We would take calls from all over Oregon and a part of Washington on airplane activities. This was during the Cold War, and our government utilized the Ground Observer Corp, a network of volunteers that recorded all the airplane activity in coastal areas of the nation. We would take the calls from the outposts all over Oregon and record and follow them on the large map, placing a replica of an airplane on the large board. We then would report any suspicious activity to the military.
The Army
Now, mid-1956, after a year there, I received my draft notice from the Draft Board, also known as the Selective Service. The Korean War was recently over, and things were still unstable. So, in mid-July of 1956 I was drafted into the Army. I was flown to Fort Ord, South of San Francisco and was processed in. Somehow, I am still not sure, I had found out the MOS (Military Occupation Specialty) number for a Med Tech and while filling in the forms that they had me fill out, I found where there was spot to put in the MOS number. I do not think it was a field that I was supposed to fill in. It was probably for them to assign me a number later.
Anyway, it worked. I was partially through basic training, when I was given orders to go to the Army hospital at Fort Leavenworth, Kansas, home of the Army Command and General Staff College. On my first day there, I was asked to do ECG’s. (Most people know them as “EKG.” The “K” comes from the German or Dutch Kardio; English would be Cardio, the “C” in ECG.) In those early years, most lab techs learned to do ECG’s as well as most X-ray techs.
That was an interesting Army base, and I loved the work there. We had our own blood bank and would draw all our own donors, for blood for patients at the large Army hospital. Our donors were from the military prison, which was on the base. It was voluntary for those prisoners, and we had no problem getting donors. They were happy to lose a pint of blood to get out of prison. For about six months, I performed all the blood draws and did all the processing of donor blood. I also worked in Microbiology and Parasitology, which I enjoyed. Interestingly, from a proficiency standpoint, we would not have been able to comply in Microbiology. We never had susceptibility disks for Micro that were not expired, the military seemed to be OK with expired discs.
On one of the last weeks that I was still there in July 1958, I volunteered to give flu vaccine injections at the prison. There were about 375 prisoners that I gave the injection to, including one prisoner on Death Row. He asked me not to give him the shot, because he did not like needles, and he said, “Anyway, they are going to hang me in ten days.” I told him, this was the Army, but I would go back and ask the captain if I could skip him under those circumstances. I went back and told the captain the story, and he with no concern for the prisoner said, “No, give him his shot, we do not want him getting sick. Then we would have to postpone the hanging.” I went back and gave it to him. Then 10 days later, I was processed out on the 18th of July, I was driving back toward Oregon. As I was going through western Kansas, listening to the radio, I heard an announcement that “Abraham Thomas was hanged by the neck until dead” at Fort Leavenworth, Kansas on the 23rd of July. A lot of good that flu shot did.
More schooling and a job at Salem Hospital
I arrived home in Oregon and found that the Oregon Technical Institute was now giving associate’s degrees. Since I graduated, they had changed from the Oregon Department of Education to the Oregon Department of Higher Education. I found that if I was to go for just one more term, I would be able to get the associate’s degree. So, until school started in the fall, I got a job working for my future brother-in-law as a masonry tender, mixing mortar and handling bricks and stones for the masons.
When school started, I worked with the “Annual Yearbook” staff and was asked to be the editor of the yearbook. And they would allow me to take any program for free if I stayed for one more term. So, I decided to take the Radiology program for one term since in my previous work in the clinic in Silverton, I had taken some x-rays and decided it would be good to learn a little more. It came in handy years later while covering for a lab tech in a small town for a few days. I was working in the lab when someone walked in and told me the patient in X-ray was ready for her Gall Bladder x-rays. I did not know that I was supposed to do x-rays for this lab tech also. It was common practice at some locations in those early years for lab and x-ray to be done by the same person.
Spring of 1959. Now I was ready for a permanent job. No interruptions by the military, still single, and back living at home. I wanted to get a job at the larger hospital in Salem, but the pathologist who also had a side lab downtown needed someone for about six months in his small lab in the basement of the tallest building in downtown (11 stories). I took the job, with the confirmation when that closed, I would be going to the hospital lab. The basement was pretty primitive; it even had the rabbit hutches with rabbits I had to take care of. As in Portland, doctors were still in 1959 ordering BMR’s for thyroid testing. I also did frog tests if ordered for pregnancy tests as they were less expensive than the rabbit tests. We still did the rabbit test for pregnancy if the doctor wanted it. Still no proficiency testing for chemistries, I would use my own blood as a control when needed. We were able about then to start getting vials of control serum that we could use as controls, as they listed the chemical contents of the different analytes. We now had some quality control.
Winter of 1959 and I was able get the job in the hospital. It had a lab of about six to eight techs. We were also expected to take calls for the after-hours orders. At that time, “call” was when we would be asked to come from home to do a lab test on a patient after the lab staff had gone home, which was usually from 9 in the evening until 6:30 in the morning when two techs would start the blood draws. We were paid $2.50 for each call back. This money was paid by the patient, and we did not clock-in to the lab. Many times, I would be called in from home as much as three times in one night and then have to go again at 6:30 to work. I did this about every third night, all the six years that I worked at the hospital, as I always took call for one other person who did not want to take call for the extra money.
At this hospital, we had a multichannel AutoAnalyzer. But for the first few years it was used only for glucose and BUN’s; later it was expanded to 12 channels. Now in the 60’s, we were using more control sera and getting proficiency testing through a national company, and the state Lab started sending bacteriology specimen unknowns for us to report on. We started performing the Hycel PBI (Protein Bound Iodine) test for thyroid testing, which John J. Moran developed some years before. In 1957, while in the Army, I attended a National Lab Convention in Oklahoma, and John J. Moran had a workshop for us on his Hycel technique for PBI’s. So, I was elected to start performing PBI’s every Thursday morning starting at about 4 a.m. as the testing took about 8 hours to run. It was a tedious job using toxic acids and chemicals. I once aspirated some “acid dichromate” solution when I was pipetting. That was much worse than when I aspirated blood.
We got much chemical interference on the PBI testing from iodine compounds used by doctors on x-ray patients, and frequently it also contaminated the next test in the series. Blood gases were still being done on the Van Slyke apparatus using the mercury method for CO2. We would have a large 500 ml Erylenmeyer flask almost full of liquid mercury on hand all the time. We also had a pH meter for blood pH’s, but I did not trust the aqueous standard. If I set it to the indicated pH using that solution, the patient would be way off. We did not get many, but when we did, I would draw my own blood and use it as the standard and set it at pH 7.37 and then run the patient.
My other duties included helping with the nuclear medicine testing, which at that time was performed by the hospital laboratory. I also did all the gastric analysis tests, which involved placing the nasogastric tube in the patients, down through their nose. I did them, as no one else wanted the job, and I had the experience. In May of 1960 I got married to my wife Mary Jane Kaufman and over the next 15 years we had 10 children, five girls and five boys. I continued working at the hospital through part of 1966.
The laboratory sixty years ago
How did we do microbiology in the 1960’s? It was much more manual and labor intensive than it is now. We made all our culture media and poured our own plates and tube slants. We even made the more difficult to make media, such as the Petragnani agar slants and Lowenstein-Jensen media to grow the tuberculosis cultures on. For blood and chocolate agar, we used our own blood. We would just take out 20 cc of our blood and put it into the liquid media when the media was cooled down to the correct temperature. I always gauged the temperature of the media by using my cheek against the flask of media, as we could not place a non-sterile thermometer into the media to test the temperature. The temperature of the liquid media needed to be just right, or the media would either be lumpy if too cool, or the blood would hemolyze if the media was too hot. For the chocolate agar, we let the red cells hemolyze and it would be chocolate colored, which was used for the Neisseria cultures. After inoculation, we placed the agar plates in a candle jar to reduce the oxygen content. During the middle 60’s we learned that the use of our own blood, which had antibodies to Hemophilus organisms, prevented the growth of the fastidious organisms. After that, we started using sheep blood. We needed to be able to grow Hemophilus, as it can be a pathogen in the throat, and can also cause meningitis.
During these years, all the lab techs would draw the blood in the lab — at that time, we did not have phlebotomists. I really enjoyed going to the patient to draw their blood. One time I was sent to draw the blood on a patient named Amelia Earhart, you know, like the one that flew around the world and died in the South Pacific when I was about eight years old. Turns out, she was Amelia’s aunt. She told me that they named her “Amelia” after her. Another time, I went to a patient to draw blood, and the nurse said that the surgeon tried to put in an “intercath” on the patient but was unable to get it in. So, I asked her for the intercath set and was able to put it in for them. In another hospital, when I was working for the lab “on call,” the nurses told me that they had gotten the new “intercaths” but that none of them wanted to be the first ones to try to do it. I told them I would try it, and it worked. Over the years of my working in labs, I have done about 113,000 blood draws.
In 1965, my wife and I bought acreage with the intention of building a house out in the country. A year later, I quit the hospital job and started working at a physician’s office lab. With more time off, like every evening, I built a shop after hours, which took about a year and a half to build. Then in 1968, we hired my uncle to build our house. While the house was being built, our whole family at that time (wife, five children, and I) lived in that shop. It was crowded but it worked out well. I did some of the work on the house myself, such as sheeting the roof and all the electrical wiring. This took about a year, and we moved into the house the day the astronauts landed on the moon.
In this doctor’s office lab, I was the lab director. While working there, I became interested in the billing of lab tests using CPT (current procedural terminology) codes. This job gave me better hours, with no on-call, except on Saturdays I still needed to work on the microbiology if I had any cultures growing. Here I performed all the blood counts by hand and counted them on a hemocytometer; I did all the white cell differentials by hand also. For a while, I did the Rose Bengal radioactive liver function tests. I did have a Hycel Carousel for doing some of the chemistry tests. It allowed me to do them quicker, but it was essentially still by hand.
I also looked at a lot of spinal fluids for cell counts when the physicians would draw the spinal fluid on patients who had symptoms of meningitis, or something where the spinal fluid would need to be examined. Whenever I would be handed the three tubes that the physician placed the spinal fluid into, I would hold the third tube up to the light and lightly swirl it and visually estimate the cell count with my naked eyes (I had better vision then). I would be able to estimate the number of cells to about 10% of the actual count done on the counting chamber under the microscope. I always did the cell counts on the hemocytometer also. One time, one of our children needed to have a spinal tap done at the hospital by the pediatrician. I went with my child to the emergency room where he performed the aspiration and handed me the three tubes as the doctors usually would. I did the same thing there and looked at the cells in the tube and told the doctor that there appeared to be about 40 cells per/cubic mm. He kind of chuckled, and said, “We will send it up to the lab anyway.” Later, I found out that the hospital lab test arrived at 39 cells per/cubic mm.
I worked in the doctor’s office lab for about ten years and during that time met many interesting patients, while drawing their blood or other tests. For example, one was a lady from Estonia. She came over when she was young, and her first job was to assist Mr. and Mrs. Thomas Edison in their home in their old age. Some of the frequent guests at the Edison home were Harvey Firestone, John Burroughs, and Henry Ford — these four men had referred to themselves as the Four Vagabonds in reference to their summer travels together in their younger years. She let me read a four-page story that she wrote about her experiences while working for them, and it was certainly very interesting, I now wish that I had copied it.
I was getting my history lesson right here in the lab. Another lady lived in England in her youth and would see Queen Victoria ride by her home every day in a carriage. Yet another was a relative of the Holy Roman Emperor of Austria, and she actually grew up in the royal palace in Vienna. She mentioned taking a sailing trip with the Emperor all the way to Siam (now called Thailand) in a royal yacht. She later visited her relatives in Russia, the Czar and his family, and while there they had a “coming out party” for her, at eighteen, and even Grigori Rasputin the monk that helped treat the young Tsarevich Alexei of his episodes of Hemophilia, was in attendance. Unluckily, she was there in Russia when World War I started and was not able return to Austria, but later met an American car salesman, got married and, and came to the United States.
I met an interesting crop duster pilot who was very accomplished. Once he flew over the Salem, OR airport runway flying upside down in his biplane and picked up a handkerchief that a very brave man held up for him. That took skill, think about it, flying upside down and reaching for that handkerchief. Not crashing and not killing the man holding it up. Another patient was an actor who was part of the team in the movie One Flew Over the Cuckoo’s Nest, which was filmed by me in Salem at the Oregon State Hospital. It is amazing how interesting it is to draw blood on people and hear the stories they have to tell.
In the lab, I would prepare the hydrochloric acid for the Bernstein test that the doctor used on patients who had symptoms of hiatal hernia. I would dilute it, and then to be sure it was correct, I would drink some of it, swirling it around in my mouth first to be sure it would not injure the patient. We were still injecting patients with BSP dye (Bromsulphalein) as a liver function test. We would draw a blood sample before the dye injection, inject the dye, and then inject more 45 minutes afterwards. This would determine the percentage dye removal by the liver. That was a very common liver function test at the time. Another test that I did not like doing, because it was so inaccurate, was the cephalin cholesterol flocculation, also used for liver function. It was so subjective, as the reading was reported as 1+, or 2+ or 3+ or 4+ based on the amount of flocculation, and any two persons could read it as a different plus level. I was relieved when the test was finally discontinued around 1975, but for about 40 more years Medicare was still paying for that test if billed, and it was really worthless. I also had a patient that had a 4+ syphilis test, who had been treated in Europe when she was young, and here she still lived to be 98 years old. I kept her serum for my syphilis test control and did not need to buy one.
During those years in the 60’s and 70’s we were able to buy control sera for most of the chemistry tests. I was doing quite a bit of microbiology, mostly urines and throats. Oregon started a group A strep survey for all regulated labs. When I received the ten samples, I cultured them, and as usual, the next day when I opened the incubator and took out the plates, I first sniffed them as many microbiologists do, as the odor of the colonies is quite diagnostic. I would first mark down the positives and negatives by the “Sniff test,” then read them visually for the distinctive hemolysis that the group A streps showed on the blood agar. I had a problem, one of the tests was positive on the “Sniff test” and was negative for the hemolysis test. I ended up going by the Sniff test and was correct; the State also had it positive. The sniff test was actually similar to the testing that is now used by some of the newer instruments that are able to determine the bacterial biochemical end-product with great precision.
Finding solutions to laboratory coding and reimbursement
During my time in the Clinic, I was asked by the billing department why Medicaid did not pay for the VDRL tests I was doing in the lab. I contacted Medicaid and was told that they only paid for the syphilis test if it was a Kolmer test. To me that did not make much sense, as most labs were performing the VDRL, and if positive, would send it to the state lab to have a Kolmer test done.
I then communicated with the personnel at Oregon Medicaid and gave them a good reason why they should pay for the VDRL test. After that, they started calling me and asking questions on lab testing. I was very helpful, and they appreciated the assistance. Not long after that, Linda at Medicaid called me and asked if I would be willing to be their “lab consultant,” as they did not know anything about lab work. I accepted and started working as a consultant for them on an as-needed basis, mainly during lunch hours or before work, as I still had my full-time lab job at the clinic.
Soon, they asked if I could assist them with radiology coding, and I said I could, as I felt comfortable with that specialty also. Not long after that, they asked me if I could help with the surgery coding, but there I had to tell them I could not help them. This work with Medicaid went on for a total of 14 years. This business of CPT coding became very interesting to me and was a valuable skill as hardly anyone in the lab or radiology departments were very proficient at it, and this is how they were getting paid for their work.
In 1972, I started working at a local vocational school for Medical Office Assistants one evening a week beside my lab job at the medical clinic and my state job. This lasted about four years until it was closed. This was about a three-hour class once a week, and I taught lab techniques that would commonly be performed in an office that had no qualified lab tech, as many doctors wanted to have some of the simple tests done in their offices. After all the students were proficient with their venipuncture technique, I showed them the grand finale of blood draws. It was to draw blood out of my left arm with my right arm but having both arms behind my back. I would never be able to do that anymore.
Now by 1976, our family had increased to ten children: five girls and five boys. I started a new job working for a small independent lab doing microbiology. This allowed me to spend a few hours a day as a consultant for the state Medicaid agency, and as I was starting to see that the state was over paying on some of their billings, because their payment system did not capture all the digits that were being billed by the pathologists and radiologists. Not capturing all the digits caused them to overpay those clients when only the professional component was being billed. They were actually paying the professional component at the same rate as they were paying for the full service. This was an overpayment of about 200%.
I was able to show Medicaid administration that for every hour that I worked for them auditing their billing, I was saving them 27 dollars. They were paying pathologists and radiologists the same amount for just interpretating the lab tissue exam or x-ray as they were paying a free-standing facility for performing the whole procedure. For example, the CPT code for a tissue exam was, say 88305, but the CPT code for the interpretation only, was 88305-26. The computer service that assisted Oregon Medicaid in setting up the MMIS (Medicaid Management Information System) was just reading the first five characters, as their system allowed only 5 characters in the CPT billing code field.
Using that system, it overpaid when lab and radiology billed a modifier such as “26” to the code 88305. I asked the computer gurus if there was some way for the computer to read more than five characters in that five-character field, and they said, no. So, I was able to come up with a method that would allow lab and radiology to bill their professional components and get paid correctly. I set up their fee schedule to list the last digit in the five-digit code as an alpha character if it represented the professional component (26). So, every last character that ended with 0 would be listed as an A and the 1 would be represented as a B, the 2 as a C, the 3 as a D, the 4 as a E, the 5 as an F, on through the letter J. That way, the code 8830526 would be listed as 8830F. It worked, and that way the system paid the professional component correctly and saved a bundle. During some of those years, I also worked as the Medicare Lab & Radiology Consultant for the Oregon Medicare Carrier, Aetna. I did the same type of work for them as I did for Medicaid.
Laboratory drama
In the mid 70’s, there was an incident that will be of interest to CDC personnel. We were having our National Convention in Portland at one of the large hotels and there were about 700 MT’s attending. On the first day, we had our lunch in the large dining room where it was a buffet style meal, with a large salad bowl about three feet in diameter full of mixed salad. Nothing happened that day, but on the second day there were many of the attendees who had sore throats. On the third day, at least half of the attendees had already cultured their throats and said they had group A strep. You know lab techs, if you have a sore throat, you will culture it and see what it is. Anyway, they talked with the hotel administration and were able to locate the person that mixed the salad and found that he had a boil on his forearm. A culture was taken and sent to the CDC, and of course, they also sent samples of the organisms that the lab techs had cultured out and they were all the same serotype or phage type. Where but at a lab tech’s convention would something like this be determined that rapidly.
We have always depended on the CDC to quickly perform studies on the organisms that we could not identify. And in this instance, they really came through with flying colors. It was amazing, that from that one little boil on his forearm, he could contaminate a large mixed salad that over 50% of the people ate and subsequently got infected. It is hard to comprehend how that was possible. About a year later, a lawyer had a class action suit that covered all that were infected, and each got a small settlement. I got $109.89. Some of the attendees were sick enough that they were hospitalized.
In 1980, the State asked me to work more hours, so I put in about 35 hours a week. I had also started a tree nursery, growing trees for different buyers, this lasted until 1987. I did that on the side beside the other jobs, as I was still moonlighting for two small hospitals that had only one lab tech, and that person needed to be relieved off and on from his 24-hour position. On a Saturday, I pressure washed the roof of my house and was almost done with the shop roof when I slipped on the wet shingles and fell to the ground and fractured my pelvis. I was in the hospital over the weekend and was able to work again by Monday, but I was on crutches for a month or more while it was healing.
In the early 80’s we started seeing HIV patients, it really was quite concerning as the infectiousness was really not known. I also worked on the side as a mobile phlebotomist for a home health agency and was sent to draw blood from a patient that was very near death from HIV. His arms were black, and he was very ill. The doctor ordered a hemoglobin and hematocrit as he was quite anemic. I could not get any blood from his veins and had to resort to doing a finger puncture and with my mouth draw up the blood in a pipette for the hemoglobin and then aspirate and blow back in the tube to mix the blood with the cyanmethemoglobin solution, all the while wondering how many HIV molecules I was aspirating. It has now been over 40 years, so I feel it did not get infected. But that is the danger that a lab tech is in, in this field.
In 1984, the first bioterrorist attack in the United States took place by the Rajneeshpuram community, who were followers of Bhagwan Shree Rajneesh, in Wasco County, Oregon. When working for Medicaid, I frequently looked at some of the culture charges coming from a lab in Antelope, Oregon, which was located in the medical clinic serving the Rajneeshpuram settlement. So, I knew they had a microbiology department, and I would help them with their billing codes. Little did I know that they were also up to something nefarious, with their growing of salmonella as we later found out.
The Bhagwan Shree Rajneesh and his helper Ma Anand Sheela conspired to take over Wasco County in an election in the 1980’s by importing large numbers of followers just before the election and at the same time poison the salad and food in the main city in Wasco County, called The Dalles. It worked partially, as they were able to poison and sicken 751 people mainly in The Dalles with salmonella, and 45 were hospitalized, but fortunately none died. Oregon’s Secretary of State also was able to increase the number of days before an election that people had to sign up to vote, so the number of the Rajneesh followers were reduced, and they were not able to swing the election in that county. So that terrorist activity fizzled with no deaths.
While working in the federally qualified health center (FQHC) West Salem Clinic lab, we once had a very interesting experience in parasitology that was unique. The patient had recently come from West Africa and was complaining of an eye problem. The doctor examined the patient and while he was looking at the eye a very amazing thing happened. Right out of the corner of the patient’s eye a little wiggly parasitic worm started coming out. We knew right away what it was, it was a Loa loa, one of the blood and tissue flagellates we had studied at Oregon Tech but had never seen as a live specimen. We stained blood from this patient and found many microfilariae with their delicate undulating membrane, it was exciting for us to see.
Our chief tech was Malcome Eaton, MT. He had been in the Marines and for a few years was to guard the President. He related one episode when they were in the Blair House (The White House was being renovated) when there was some shooting outside. Right away, President Truman jumped up to the window to look what the excitement was. Of course, Malcome and his buddy had to take President Truman down and place him on the sofa, and one of them laid down on top of him to protect him. Something rather unique for a president was that every evening Bessie Truman would wash the dishes and President Truman would dry them.
Transitions
My job at the State of Oregon ended in 1986, due to their cutting out the consultants because of budget constraints. In 1984, I had already started working 1–2 days a week in the lab at the West Salem Clinic as noted above. I then started working for doctor’s office labs and independent laboratories as a laboratory billing code consultant. As noted earlier, labs were not very proficient at billing all their procedures with the correct CPT codes by the AMA and HCPCS (Healthcare Common Procedural Coding System) or HCFA (Health Care Finance Administration) by CMS and insurance companies. Other coding that is also important, is to assign the correct Revenue and Certification Specialty codes, which many labs were not familiar with.
The Medicare program now started to pay hospital labs from a fee schedule, instead of by audited cost. Labs now had to correctly use many different and unique codes, and if incorrect denied payment, and in many cases the billing departments did not know why they were being denied. Labs and x-ray departments were just not very good at billing all those different tests correctly, and they were hurting.
Conclusion
This covers the first part of my career of 75 years in the lab field. And it really has been an exciting profession. I would never hesitate to recommend it to anyone looking for a challenging career. To this day, I am still working as a lab consultant, it is still a challenge, even though I am no longer meeting patients. I do miss the part of seeing and working with the patients. But presently, most lab professionals also are not seeing patients, except for the phlebotomists. The next 39 years of my career are quite different, as it was primarily going on location to large medical centers to work with the lab managers on correct coding and reimbursement and giving lectures on coding. Most of these 39 years were the most exciting, as they involved going all over the nation to labs and helping them become more efficient in billing for the work they were performing. I even went to the Mayo, Cleveland, and Ochsner Clinics and helped them, all the major reference labs in the country, and hundreds of hospitals of all sizes.
It was not unusual to go to a large university medical center and in three days tell the CFO on my exit review that the following year their lab would bring in about a half million more in revenue, just from my coding review. But I did not reveal to them that I had only gone to the eighth grade in a little one room school and was the lone graduate in my eighth-grade class. The last 8 years of those 39 are without travel, working on the internet from home as a lab consultant for a limited number of lab clients.
