Tran1 or Tran2?

The interesting thing about working at a university in a staff role is that those roles, especially the ones lower on the totem pole, tend to be populated with people who are working the job as a means to a different end.

There were four of us who worked the front desk at the Derm/Surg clinic:

  • Barbara, getting her MS in Social Work.
  • Jayette, using the job to fund her role as a community choir director.
  • Jule, getting her MA in Education.
  • Our boss, hoping to get her MRS, with a surgeon, not a derm doc.

If you worked this desk in the early 1980s, many breakthroughs were happening:

  • Transplantation: not just kidneys, but pancreases, livers, hearts.
  • Plastic surgery: gender reassignment.
  • Dermatology: a new acne medication study (Accutane); a new hair loss medication study (Rogaine); and a strange and frightening spike in the incidence of Kaposi’s sarcoma, predominantly among young men.

On the Surgery side, Tuesday mornings were Transplantation and Plastic. On the Derm side, all the docs were in clinic. Tuesday morning was the busiest four hours of the week.

Transplant surgery patients came to clinic for pre-surgery evaluation and post-surgery follow-up. The care team that would see them included doctors, residents, medical students and nurses from the clinic and the office.

For follow up, the routine for the patient was:

  1. Check into clinic.
  2. Get lab slip.
  3. Go to the lab and have blood drawn.
  4. Come back to clinic and wait about an hour (or longer, if morning rounds ran long).

There were two types of labs for post-transplant patients, the Tran1 (pronounced ‘trany-one’), and the Tran2 (pronounced ‘trany-two’), which was the same as Tran1 plus glucose.

If you worked the front desk long enough you gained some implicit knowledge. One of the things I learned is that the Tran1 and Tran2 patients didn’t look the same. The Tran2s were puffier looking, glossier.

One Tuesday morning a transplant patient checked in, leaned on the counter, and asked me for a trany-one slip.

Me: “ Trany-one? Are you sure?”

Patient: “I’ve been coming here for six years. I’m sure. Trany-one.”

Me: “Well… okay, but…” I bit my lip.

Patient: “Why are you asking?”

Me: “It’s just that… you look like a trany-two patient.”

Patient: “Fine. Give me the trany-two.” She leaned heavily on the counter and rolled her palm up for the lab slip.

The problem was I was a desk clerk, not authorized to change a lab order. I paged for a nurse. I looked for a resident. I paged again. I called the lab and learned that the price difference between Tran1 and Tran2 was $6. I paged again.

The patient and I waited.

I paged again.

Exhausted, exasperated, the patient leaned forward. “Honey, I don’t care,” she said, pausing to swallow. “I feel so bad. Just give me the slip.”

So, I gave her the Tran2 and hoped I wouldn’t get in trouble.

An hour later, when the care team arrived, one of the transplant nurses from the office said, “Oh, you can take Mrs. X off the list. We admitted her this morning.”

I looked at the nurse and hoped for more information.

She gave it, because medical people like to trade interesting facts. “The lab paged us. Her glucose was 660. We got it early because one of you idiots gave her the wrong slip.”

I raised my hand like a student in a classroom. “That was me,” I said. “And I did it on purpose.”

The nurse looked at me. “Sure you did,” she snorted, then turned down the hallway. “Shoulda been in a coma,” she muttered as she walked by.

PS: Normal range for fasting blood glucose is under 100.

Chewing the Cud of Good

Reese Witherspoon on the cover of TIME magazine, featuring the 100 most influential companies

Thankful that little girls now see things I never saw when I was a little girl.

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