David describes the changing nature of his work as a haematology technician over the years, how new equipment speeded up the process but also how the human touch is important.
At King’s Lynn Technical College I studied science and engineering, got my O-levels and was persuaded to do A-levels. The initial idea was I would go to university, but I was struggling and thought I would make some money. I went after several jobs in the engineering line, down London and various places, but for some reason – probably because I wasn’t qualified enough – I didn’t get them. Then on the off-chance I happened to read the King’s Lynn paper and there was a job going at the King’s Lynn hospital in their path lab. I thought, ‘Oh, I’ll go up and see what that’s like’. So I went and for some reason they decided, ’Yes, you could be just the ideal person for us’.
Pathology Lab at Kings Lynn
It was a small laboratory. There was a chief technician, a senior, and I think there were two or three others. I was there for two years and it was quite interesting. Just before I left I used to be mainly in the haematology department, which is studying red cells and white cells and what is known as ‘haemoglobin’. We would perhaps do, on a really busy day, 40 samples between me and the senior technician.
We had a machine which actually measured the haemoglobin. You put the diluted blood in the colorimeter which measured the optical density. You would then read it off a chart and you would say that this patient’s got a haemoglobin count of say 85 percent. As for counting the red cells and white cells, we used to dilute the blood down on a special microscope slide which had a graduated pattern, and you put a cover slip on and the blood was exactly one millimetre deep. Then you started your count of the cells in the various little squares. You did that for red cells and white cells and what are known as platelets, the things that help the blood clot.
Having been there for about eight weeks, they decided I ought to learn how to take blood. They decided I would learn to take finger-pricks – you prick someone’s finger, suck up some blood in a tube with diluting fluid and things, and process it. We used to have the outpatients come to a little room on the outside of the actual laboratory. I had a go at a couple of patients, and that was all right. Then they decided, ‘Right you’ve had a go at that, you can go onto the wards and do it’. So I saw the first patient and I stabbed the person’s thumb and I didn’t get anything out of it. So I went back and I said, ‘Oh, I couldn’t do it’. ‘Yes, you can, go back, you’re not returning until you’ve got that sample’. So off I went, and it was just that I was being too gentle I suppose.
The thing we used to prick people’s fingers with was a great big thick needle, called a Hagedorn needle. It was stuck into a cork; the cork and the needle were then inserted into a bottle that contained methylated spirits. And we would go round the different patients; I’d take your blood and stick the needle back in the bottle. Then I’d go and see the other five or six people; the same needle was always used. Thinking about it from today’s way of thinking, it was horrendous, but to my knowledge no-one ever came to any harm from it.
Anyway, that went on for a while and they decided that I’d learn to use a needle and a syringe by practicing on one of the other technicians. In those days we didn’t have proper tourniquets; we had a bit of rubber tubing wrapped round, tied in a knot to bring up the vein. We had glass syringes and you’d sharpen the needles occasionally on an oil stone. The needles and the syringes were sterilised I have to say. So I stuck the needle into the vein and I started to pull it out and there was blood! And I said, ‘Hey, I’ve got blood!’ and in all my excitement I just pulled the needle out of the arm and I’d got blood dripping out of the syringe, and I’d got blood dripping out of her arm. So that was quite exciting!
I got through that and then I was sent out on my own. It wasn’t a difficult job; it was just a matter of practising. It was about 18 months before they decided I really ought to be doing some training. I mean, I had learnt how to do things on a one-to-one basis but I’d never been taught the theory of it. So I went and did a bit of haematology and a bit of chemistry, and I did bacteriology, which is culturing various things.
We used in those days things like benzene and xylene and various alcohols. Xylene has now been made [found to be] carcinogenic. It was kept in an open top bottle in the lab, and was just dumped around! But we just all got on with it.
At the Norfolk & Norwich Hospital
After about two years I decided that as I was working about 15 miles from my home anyway, I might as well see if I could get a job in the Norwich – there was a job going and I got into their haematology department. I did get formal training there. It was a bigger laboratory and most of the techniques were virtually the same as they were at King’s Lynn with one major exception. Measuring haemoglobin was about a hundred years earlier. They had got this machine known as a ‘grey-wedge photometer’. It was like a telescope and had a green filter. The dilute blood was red so it sorted out the right colours. It was a reasonably accurate machine. However, one day they discovered that my results were 20 percent inaccurate. The director thought that I had to have my eyes tested. So I was frog-marched down to the eye department and I was found to have colour blindness – I had a green, colour blindness. This was a disaster! So on my return it was ordered that the haematology department would have to have a colorimeter. As it happened, the chemists had two or three spare colorimeters that had never been used, in their cupboard.
About a year later we progressed from having to count the cells under a microscope to actually having a machine that would count them. You diluted the blood down, stuck it into the machine, and it would count the red cells. And if you diluted it a different amount it would then count the white cells.
We then had this machine called a haemoglobinometer, which did basically the same thing as the colorimeter. Instead of giving the result as an optical density it would actually give it as grams of haemoglobin. So that was a major step forward. We were processing perhaps 40 or 50 blood counts a day. The girls would look under the microscope and differentiate the white cells in the same old-fashioned method, but we had moved on from having to count the cells to actually looking at them.
When I first went to Norwich we used to measure a thing called a colour index. You divided what was known as ‘pack cell volume’, by the red count. For pack cell volume, you used to get ordinary blood, suck it into a very thin capillary tube, dip the end in some plasticine-type material and stick it in this machine which spun it round at 20,000 r.p.m. Then you would have a slide rule to put your capillary tube on and you could read where the intersection was between the red cells and the plasma white cells on the top.
After about three years we progressed to a machine which measured the white cells, counted the platelets and red cells, measured the pack cell volume, and calculated what was known as the ‘mean corpuscular haemoglobin concentration’, which is the amount of haemoglobin in a cell. And it counted out the average size of the red cell; the ‘mean corpuscular volume’. So that gave seven parameters. We still had to look under the microscope and break the white cells down into their various sorts, but never mind. That was an inconvenience but we got through. We were then pushing through perhaps 100 to 150 counts a day.
After-hours, we had an on-call service. I did that after I’d been there for about 18 months. There were four of us who used to deal with the on-call. I’d learned how to cross-match blood with bottles I’d got in the fridge – it’s a matter of blood-grouping it, picking the right blood group and mixing the two together to make sure there were no problems. Anyway, you would go home at half past five and you would sit there having your dinner and then the telephone would ring, ‘Could you please come in and do a haemoglobin, white count and red count on this patient’ or, ‘Can you come in and do a blood count and cross-match three pints of blood, as this patient’s gone to theatre to have a caesarean section’, or whatever. It was quite fun but sometimes you got bad nights; you’d be called up at eleven o’clock at night; you’d get home at perhaps twelve; you’d be nicely asleep about two o’clock and the phone would go again and then perhaps a third time.
Working at the Jenny Lind Children’s Hospital
One of my jobs was to go down to the Jenny Lind Hospital. We had our own little laboratory where we could do blood counts, but mostly it was collecting blood in little tubes and taking it back to the main lab. It was quite fun. The children were very good but they were generally quite frightened.
A funny incident on the baby block – I’d been down to prick a baby’s heel and there was a doctor there who was about to do the same thing. She’d got a nurse with her and she asked for a spirit lamp, some methylated spirits, and a syringe needle. I watched her in horror! The first thing she did was light the spirit lamp; then she was going to heat the methylated spirits over the little spirit lamp. I said, ‘Look you can’t do this because the meths will catch fire!’ Then she got the book out and she said, ‘Ah yes, you swab the baby’s heel with meths. Then…‘Ah yes, stab the baby’s heel’, and she stabbed the baby’s heel… then back to the book… and then picking the heel up, squeezing it … by which time the baby’s heel had stopped bleeding. So I said, ‘Would you like me to do it, doctor, and show you how we in the lab do it?’ ‘Well, if you think you can do it’, she said. ‘Well I have done a few before’, I said. So that was that and that’s how I come to meet my wife. She was on one of the wards and I just happened to bump into her.
Senior technician at Cromer
I had been at the N&N for several years, and I thought I was getting into a bit of a rut. A couple of years after, a job came up at Cromer hospital; they wanted a senior technician over there. I was only a junior at the time so I said I was interested, and I got the job.
I went to Cromer in 1979. The chief technician had just been appointed. He was ex-R.A.F. and in charge of what was known as the chemistry department. The other technician was in charge of haematology and they wanted someone to do the blood transfusion. So I went and the rule of the post was that if the other technician got his exam before I’d completed my ten years of service (‘cos I’d decided that I wasn’t going to do my final exam), he’d get the senior post, otherwise I would. Fortunately or unfortunately for me, he decided he was going to move on. So I got the senior post after ten years. I became senior in haematology and blood transfusion. I had a technician who did the haematology and I did the blood transfusion. There was only the three of us, so at night we did one week in three. The system broke down a little every now and again because one would have a holiday for a couple of weeks and it meant that I was on alternate weeks, which became a bit tiring. I was well paid for it but I was living at Salhouse when it first started and had to travel from Salhouse to Cromer every day, which was quite a journey.
I can’t remember exactly when it was, but they decided that the lab should shut. In the meantime we had got more new equipment which by now would actually not only count the cells, measure the haemoglobin, it would also divide the white cells into their various sorts – into the basophils, eosinophils and platelets and all the rest. It was really good. We had another machine which would measure what is known as the ‘prothrombin time’ – when you put someone on an anticoagulant you had to be sure that the dose you were giving them was sufficient – I think it was then called an INR or International Normalised Ratio. The doctor would then write to change their dose accordingly.
Some of my colleagues used to think that they were haematologists. A haematologist is a consultant – there is a slight technical difference! My attitude to life was that I’m a haematology technician; I’m not interested in the medical side of things, the doctor is in charge of that. I know what I am doing with my blood tests; I don’t know what they’re doing with the patient. Of course, we did have doctors, especially the chemists, who would send down some blood for tests and then request another batch of tests. So the technician would do another batch of tests – this was usually in the night time – and sometimes there would be a third test. ‘Right, now this patient could have this, that or the other from this; can you tell me which it is?’ and I’d say, ‘Go to your registrar and get him to sort it out. I’m not the doctor, I’m only the technician and I’m not here to diagnose your patients!’ So we had things like that.
The new Norfolk and Norwich
And then they decided that they would close the lab in Cromer so I was sent back to the old Norfolk and Norwich on St Stephen’s Road. Then they decided that we were going to move up to the Colney site and needed me to help with the move.
There were no windows in the lab at all! You had no idea whether it was nine o’clock at night or three o’clock on a nice, hot, sunny afternoon. The work by now had increased. We had two or three machines and we were pumping through perhaps 400 or 500 blood counts a day. It was a sort of shift system. At half past five in the evening you took over and you packed up at 9 o’clock the following morning. You were there on your own; you filled the machines up with blood samples, they went into little racks and the machine did everything. It dumped onto a computer system and it was a matter of quickly scanning through the results. If they were normal results you just authorized them and they were sent out. If they were abnormal you would make a blood film so that someone could look at it.
I would like to say that we did have strict controls on results. We used to participate in a national quality control scheme once-a-month. We analysed three bloods and the results would go off to be compared. We were always very high up on the list of labs. We put control samples through on a daily basis and we knew that the results were within very close tolerances. However, there was just this irritating niggle that the result might well be normal but it could be significant. It wouldn’t be until it actually dropped out of the normal range that you knew there was something wrong. But in the old days we would have seen it. We’d have known what the previous result was; we could have then said, ‘Oh look, it’s actually falling’. The doctor might not have realized but you could ring him up and say, ‘Look, this haemoglobin is actually falling; it’s not just the same result fluctuating about the same’. It was generally appreciated, I think, by a lot of the doctors that you were able to let them know a bit in advance. If someone’s got hardly any haemoglobin left (they have bled most of their blood out), they’ll need massive blood transfusions.
The travelling became rather tiring again and I had spent most of my working life participating in the on-call service, which at its best was one night in five and at its worst was one night in three. I had the chance when I was sixty to retire because I’d then done my forty years of service. It’s been the best decision I ever made. I’m very happy doing what I want, when I want and I suppose if I want, to some extent. I enjoy going on holiday. I’ve got the grandchildren, with two more on the way. Our lot comes along like buses – two at a time.
David (b. 1943) talking to WISEArchive on 22nd November 2010 in North Walsham.
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