The Dark Ren

***This is part 2 of 3 of the “Epi Ren” trilogy of how I came to be who I am. Part 1 is here.”

With my graduation from college as a Medical Technologist (MT) and my move to Pennsylvania came the “dark period” of my life. You know that period, right? The time when you kind of don’t know what you want to be in life? The time in between the one stage and the next stage, when you know that the next stage is going to be the, more or less, “permanent” stage? Yeah. That stage. It was also the time when I let other people, mostly young women who just wanted to have fun, take control of the things I did, whether they wanted to or not.

I landed a great job at a 65-bed hospital in rural Pennsylvania. I was about two hours from Washington, DC, and about the same time from Philadelphia. It was only an hour and a half to Baltimore. So I had choices of places to go for fun… And I did go to those places for fun. With the great job came a great paycheck, and I was young. The world was my oyster.

However, I was completely alone in several respects. See, my entire immediate and extended family was thousands of miles away. In fact, none of them lived east of the Mississippi. Mom and/or Dad went to visit me once in a while, but, other than those random times, I was pretty much on my own. That meant that, as a male in his early 20’s, I went looking for trouble.

Trouble found me in the form of bad relationships. I mean, they were really bad. I dated chickie after chickie that was in some way, shape, or form associated with the hospital where I was working. Not only that, but they were “damaged goods”, young women with personal baggage of their own. That was bad because I was bringing my personal life into the professional life. Drama was with me 24/7. Too many distractions. My friends consisted of a few people I met while playing soccer here and there, and some of the guys that I worked with at the hospital.

Life in the lab was good, too. I worked overnights and evenings, alternating between the two. When I wasn’t working nights, I’d still stay up all night to stay acclimated. That meant going to DC for fun and frolic. It also meant hanging out with the chickies past 11pm. And nothing good happens after 11pm. But I had fun, and that was all that I really cared about at the time. Well, that and doing a good job at the lab.

Having been in the lab in one way or another since I was 14, there was basically nothing in the lab that gave me trouble. Crossmatch for ten units on a bleeder in the OR? No problem! Stat cardiac labs from the ER? No problem! Broken down machines? Hey, I worked at a lab in effing Juarez, Mexico. I could do stuff by hand. So that part was easy.

I then met my evil ex-girlfriend, the one who shall not be named. It was a bad relationship, and let’s leave it at that. At the end of that drama, I was left drowning in an ocean of uncertainty. I was angry. My work at the lab began to falter. It took me longer to get results out on specimens that were delivered to me. I would get snippy with people over the phone when they called looking for said results. And the fact that my other evil ex girlfriend worked in the ER and rubbed her wonderful life in my face did not make things better.

I don’t remember any of those days as having sunshine. All my memories of those days have an overcast sky and are dark and dreary. It’s funny how that works.

Then one night this kid comes in with a really bad headache, stiff neck, and a fever of over 105. He is sensitive to light. Basically, he has all the signs and symptoms of meningitis. It was snowing heavily outside that night as well. The physician in the emergency department did a spinal tap. I took it from him and went to the lab. The doctor told me to be really fast about turning those labs around. Once in the lab, I set up the hemocytometer to count the cells by hand. I then spun down a sample of the cerebrospinal fluid (CSF) to do chemistry analyses on it. (Low glucose and high protein mean that the bacteria are eating all available glucose. The high protein is picking up the bacteria themselves.) And then I ran to the back to do the microbiology plating and Gram stain.

Did I mention that I worked in the lab all by myself all those nights for all those years?

As soon as I had the Gram stains drying, I went back to do the cell count. I tossed in the CSF for chemistries into the analyzers as well. I could not believe my eyes when I looked into the microscope to count the number of white blood cells…

Three years before, during a ceremony before our graduation as medical technologists, a pathologist from one of our clinical rotations gave a small speech about what it meant to be a laboratorian. He told us that he remembered the first time he looked into a microscope. He said that the universe became a different, bigger place. He said he looked away from the microscope and at his microbiology teacher. His teacher, Dr. Ricardo Ortiz Piñeru, smiled, knowing that there had just been a change in his student. “It was like the sun rose over the horizon of my mind,” the speaker said, “and everything was illuminated from that moment on…”

…There were white blood cells everywhere! I didn’t even count them because there is a result that we can give: “Too Numerous To Count” or “TNTC”. I typed that into the computer system and ran back to microbiology. I wanted to see what the hell was swimming among all those white blood cells. As I looked into the Gram stained slide, I saw what was making that kid sick. There were Gram positive (purple) cocci in pairs over a pink background. These bacteria looked like little lancets as well. I picked up the phone and called the ER.

“Did the kid have his spleen removed recently?” I asked the nurse.
“What? What does that have to do with anything?” she asked.
“A lot. Can I talk to the doc?” A few moments later, the ER doc picked up the phone. “Doc, did the kid have his spleen removed recently?”
“Yes,” he answered.
“Pneumococcal meningitis!” I almost screamed.
“What? How do you know?”
“His Gram stain, doc. Gram positive cocci that look like lancets and are all in pairs. They’re everywhere. His white blood cell count in the CSF is in the thousands (should be 0-6 per mL), and the glucose/protein ratio is flipped.” I don’t remember if he had time to thank me before he hanged up the phone.

The rest of the night, the doctor was on the phone looking for an ambulance service to take the kid to a bigger, better equipped hospital. He needed advanced care and quick. Because of the snow, flying the kid out was not an option. Finally, some of the volunteer ambulance drivers showed up to try to take the kid up the road for treatment.

As we sat around the rest of the night, the doctor asked me how I knew that it was Strep pneumo. I told him about how I had learned to tell the bacteria from the Gram stain because of the bets I’d make with the Army guys in my microbiology rotation. And then I told him how I had read that people without spleens should get the pneumococcal vaccine to prevent just that kind of infections. The spleen helps deal with encapsulated organisms. “You figured it all out on your own, huh?”
“Well, you were the one that recognized the meningitis, doc.”
“Yeah, well, now I have to look into giving the family some antibiotics.” And it was then that I learned that there was this whole other side to the care of the kid, a Public Health side.

I remember going home that morning and looking up health departments and what people did there. I learned more about epidemiologists, though I knew a little from watching movies like “Outbreak” and “The Stand”. I read and read and read some more. I read about how they looked after the health of entire populations, giving advice and recommendations to physicians and other health care providers. They were the ones that ran into a place with an outbreak and offered medical care, vaccines, antibiotics, all that good stuff. And then I found out that the George Washington University has a program in epidemiology that was among the best in the nation. Not too long after that day, I had a dream that a bunch of people came to our hospital with fevers. Some of them were convulsing and falling on the floor. One of the nurses ran up to me and asked me what to do… And I didn’t know what to do.

I went back to the GW webpage about their Master of Public Health degree in Epidemiology and clicked on their instructions for applying. The time had come to do those things that I needed to do before the time of other things came. Oh, and things would come.

I remember the sun rising right around that time.

That same year, a new coronavirus was spreading like wildfire in Southeast Asia… SARS nudged me forward to learning to be one of the people who stand on the “walls” of the world looking out for things like it. But that required getting admitted to GW. With the bad grades from my undergrad years, when I was distracted with teenage things, it was going to be hard to get accepted and prove that I could contribute to Public Health.

The story of how I got myself accepted, and what I’ve been up to since then, is best left for the last part, when “Epi Ren Rises”.

I'm a doctoral candidate in the Doctor of Public Health program at the Johns Hopkins University Bloomberg School of Public Health. All opinions posted here are my own, of course, and they do not necessarily reflect the opinions of my school, employers, friends, family, etc. Feel free to follow me on Twitter: @EpiRen