Pushing Glass-The Clinical Laboratory

Blood Brothers

Dan's heels clicked at a rapid cadence. He was a man on a mission when he spied James. “Dr. Deeeeeetaaaaan! I need you now!”

James was in his office and had closed his door except for a small crack when he heard the familiar gait. The door swung aside to reveal the familiar long white coat.

"James, you were scheduled to be on hematopathology with Haas this month but we need to juggle the schedule. You'll be doing outpatient pathology at ULS with Nomura."

"Lot of juggling going on, recently. Thanks."

"Don't thank me...you'll probably be cursing me before the month is complete. You'll be pushing glass 24/7."

"I can push glass."

"Yeah, right. Nomura is expecting you, the drive takes about 10 minutes. You know where the lab is, right?"

James nodded. A courier shuttled specimens between the hospital and the lab on an hourly basis but James preferred his own car. The short commute was a welcome respite from the enclosed laboratory. The weather had grown cooler with the approach of fall. The trees lining the streets dropped yellow and gold reminders. So peaceful, James thought. There were no seasons in the Philippines, at least not ones which were announced by the foliage. James pulled alongside the parking spots designated for patients. The sliding glass doors were decorated with bold white letters that proclaimed United Laboratory Services.

"Sign in and drop your order in the box." A young man with spiked blond hair sat behind the reception desk and motioned to James.

"I'm Dr. James Deetan, pathologist. Dr. Nomura is expecting me."

"Hang on." Without looking up, the man punched the intercom.

"Yes?" Nomura's familiar voice emerged.

"There's a James Deetan here to see you."

"Send him in."

"Ok, James, you can go back. It's down the hall, third door on the left."

A few curious eyes followed James as he entered the hall. Turning at the door, he was relieved to see Nomura.

"Welcome to ULS!"

Flats of slides and paperwork were piled high in front of Nomura, nearly obscured by the mound.

"Hello Dr. Nomura."

"Bit different than Memorial, eh?"

"Certainly more informal."

Nomura nodded. "Its big business. Pathology's a commodity to them. Look at this." Nomura pointed to the stack of work. "They expect us to do a day's worth of work in half the time and with half the reimbursement. Everything is capitated, better get used to it."

"Where should I start?"

"Hope you keep that enthusiasm. There's no time to preview slides, like at the hospital. You'll have to double head with me as we look at each slide cold. Sorry, there's just too much work here to do it any other way."

"I don't mind, I can see you're swamped."

For the next hour, James and Nomura completed dozens of cases. Every few seconds, Nomura's dictations rambled off another microscopic description and diagnosis. The cases cleared from the desk but were replaced with new flats brought in by histotechs. Unnoticed by James, he thought for sure there were reproducing, a twisted act of nature.

"Let's take a break."

"Sounds good. Is there coffee somewhere?"

"Yes, around the corner by the transcriptionists. I'll go with you."

Curious eyes followed James. Maroon cubicles subdivided the room into several different workspaces. The incessant clicking of computer keyboards permeated the area.

"Transcriptionists. I'll introduce you later during lunch."

"Well, a new pathologist?"

A voice bellowed from behind James. It belonged to a short, rotund man with thin wisps of black hair covering a shiny pate. His reading glasses were precariously perched on his nose.

"Gene, this is one of our residents, James Deetan."

"Pleased to meet 'ya, James. I'm Eugene Carlisle, CEO of ULS."

"James will be here through the next month."

"Good! Can I take him for awhile, Masao?"

"Be my guest. James, you can catch up with me after you speak to Gene. Take your time."

Carlisle placed a paternal arm around James and ushered him into his office. It was commodious, compared to the office they were working in. Framed pictures of children, horses, and snow-capped mountains adorned the wall behind his chair. Tiers of overloaded shelves surrounded the desk. An open folder with several graphs in a rainbow of colors lay waiting for review.

"Masao's a dermatopathologist, right? You know, a colleague of mine told me that dermpath is easy, 99% of your diagnoses can be narrowed down to five diseases."

This was the first time James had spoken to a CEO of any company. Why would he even care what he thought? Did he speak to every resident like this? James' eyes darted between the framed pictures, the open folder, and Carlisle who sat in front of him. He searched for an appropriate answer, one that would reassure both Carlisle and himself.

"I don't think...it's that easy."

"No?"

"Even if it were true..." James was emoldened, "you're not concerned about the routine cases. You're concerned about that 1% of cases that may bounce on you." He would defend Nomura's honor.

"What do you mean, bounce?"

"How do you know when you don't know? Dr. Nomura is valuable because he can diagnose those 1% of cases that will cause you trouble. It's those 1% of cases that may lead to a lawsuit."

"I see your point. Very interesting...I like you James. Let me show you something." Carlisle pointed to the graphs on his desk. "These are the revenue numbers for our regional labs across the country. The red line is St. Louis. What do you think?"

"St. Louis has the greatest revenue of all the regional labs."

"Yes and do you know how we did it?"

James shook his head.

"You!"

"Me?"

"The pathologists at Memorial are the best, makes it so easy to sell our services when we have people like Nomura and Haas signing out the cases. Since we've partnered, we've doubled our volume in less than a year. But the bottom line is we've cut costs by 40%, that's why we're doing so well. We've raised the bar and set the standard of laboratory efficiency. Memorial sent their lab manager over to us when they saw the results. Their administrators made them reduce their staffing by 30% and more cuts are on the way!"

James averted his eyes from the broad grin that dripped from Carlisle's face. He heard talk of these cuts even when he was working at Carter's lab.

"Do you know Birkman Laboratory?"

"They have a lab in St. Louis, North County."

"They do. They were here first but we've caught up with them and surpassed them in volume. See this other chart?" Carlisle produced another chart with two sloped curves. "It's just us and them now. We've acquired nearly every lab in the mid-west. They're ahead of us in the South. We're duking it out on the two coasts."

"I think North County Hospital uses Birkman as their reference lab."

"They do, very good. Every hospital has picked their sides. A few months ago, we found out Birkman was giving away free testing to gain market share. But we were more clever, and may I add, legal. We positioned our own phlebotomists within the offices of the larger physician groups so that their patients would not have to travel to remote draw stations to have their blood work done." Carlisle grinned. "Always one step ahead of them. Our shareholders are happy!"

"Thanks for the welcome, Mr. Carlisle."

"It's Gene, James. You'll like it here, everyone does. We run a tight ship but we make sure we have fun."

James forced a smile. "I can see that! Thanks Gene."

Turning to leave the office, his eyes caught a glimpse of an electronic display board with running red letters. Intrigued, he follwed the glowing letters to the source, an auditorium large enough to hold two basketball courts. It was filled with dozens of gray cubicles each housing a person with a phone headset and a glowing computer screen. Bits of the conversations were overhead as he circled the arena. "Yes Doctor...I'm sorry we missed the pickup...we'll send someone right away....we don't know why the blood glucose wasn't done....yes sir, we should have notified you of the delay in the case..."

The display board letters girded the top of the room and the once cryptic symbol were now clearly visible. "Fourty seven calls waiting....Average wait time 17 minutes...."

"Can I help you?"

James turned to the friendly voice. A tall woman with tossled brown locks and reading glasses smiled at him. Her name tag on her labcoat prominently displayed DORIS. Under this header was her last name Stanley in smaller letters; below this, her title, Supervisor Client Services."

"Hello. Sorry, just browsing."

"You don't have a name tag but I'm assuming you're one of the pathologists? Am I right?"

"Dr. James Deetan, pleased to meet you."

"First day here?"

"Yes, maam."

"I'm Doris Stanley. I'm the supervisor of the client services department for ULS."

"It's a very impressive operation. I feel like I'm in a telethon."

Doris laughed. "That's funny, never heard anyone describe it like that before! It's sometimes as entertaining as a telethon."

"Well, I'm sure it's a difficult job."

"Yes, try taking care of all the client issues with half the staff you started the year with." The smile left her face as easily it had appeared.

James surveyed the room. "But you're having fun, right?"

"Sure, who wouldn't?" Doris flashed a wry smile.

"I hope to see you again."

"Don't worry, you will!" James shuddered as to the meaning of that comment. A few steps later, he was back with Nomura.

"So, you get to hear the Sermon on the Mount from Gene?"

James nodded. "This is definitely not Memorial. I feel sorry for all the people who have lost their jobs due to the downsizing."

"Have to make that bottom line grow, James. When I came to St. Louis twenty years ago, there were so many little labs. It's hard to believe how fast those two blood brothers have swallowed up all the competition."

"More like Cain and Abel."

"Perhaps. Which one is ULS?"

James' eyes opened wide. "I don't even want to guess."

Nomura laughed. "Me neither. Let's break for lunch, I hear the roach coach approaching in the parking lot."

As James and Nomura headed toward the entrance of the building, the young man at the reception table yelled out, "Hey James. You have to go to HR to get an ID badge."

Nomura smiled at James as he lifted his hand, "Remember, don't forget to have fun."