I've begun to find my morning routine at Jude Ann. After squeezing past the friends and family members and other various supplicants at the gate, and after a one-glance appraisal of the courtyard and the relative density of pregnant women therein (we're always busy, but are we less busy or more busy today?), and after depositing my bag and various papers in our tiny office, I go directly to the lab. It's ten steps down the corridor past our office, and the corridor--already narrow--is made even more narrow because there are usually people waiting on a bench for the nurse who does HIV counselling and testing, a necessary step before accepting them as a blood donor. The donors are friends and family members of women who have been told that they may need surgery, or who have been diagnosed with anemia.
My first stop is the lab because I want to check our blood bank. I don't know much about clinical laboratories despite being nominally responsible for supervising this one. It's a completely different entity than the biochemistry/molecular biology labs that I worked in years ago as a undergraduate student. Regardless, I say hello to the lab techs, look at the whiteboard which tallies our inventory, and open the fridge to see how many units of blood are inside. It varies from about five to twenty.
Last I checked (on Saturday), we were short on type A. We are always short on anything Rh negative. But in general, lately, our blood bank has been doing fairly well. This is good because if one of our patients is desperately in need of a transfusion that we can't provide, it means that someone will spend a lot of time and energy trying to borrow a unit or two from elsewhere. That's why I check: if someone is going to spend their day chasing blood, it's best to start early. And it's never guaranteed to be a fruitful search.
And when I say "severe anemia", I really mean it. We regularly have patients with hemoglobin levels in the 40's (normal in women is about 120 or higher; most people will tolerate anything above 100; and research trying to balance the risks and side effects of transfusion against the risks of anemia suggests to hold off on transfusion if hemoglobin is 70 or higher). One patient, for whom we were trying to find some O negative, waited four days with a hemoglobin of 30 or so because my trip to the Haitian Red Cross ended in futility. (Eventually we found a donor for her, and she improved and was discharged in good condition.)