C H A P T E R      F O U R

Looking Through The Window Of Conscience.

Many times, the limitation of our experience robs us of the true realities of life. We become dogmatized by textbook facts and especially superficial experience. A person today is a collection of his yesterday's experience. Experience is the greatest teacher of all.

Initially at St. Lara Hospital laboratory, I was a very dedicated worker without questioning the morals of the establishment. While I was single, I worked all kinds of horrible schedules including working every holiday and weekend. Rarely did I ever call in sick. In winter of 1982 during the big snow storm when most people could not come to work, I was the only tech on duty. I worked from Friday evening till Monday evening non-stop, working a total of six-eight-hour shifts in a row. I believed I set a record. But, I did not receive any medal or trophy from the hospital except a written acknowledgment in the hospital bulletin.

While I was working hard to improve patient care at St. Lara's, another window of the world opened before me. It exposed the painful ills of the medical profession I had chosen. My exposure to tropical medicine while doing research at home and the few graduate courses I took in medical school gave me knowledge to analyze many tests performed at the hospital. In view of this, I started asking questions about patient's treatment failures, suffering and for the most painful part, their untimely deaths. This was a world exposed only to those who worked at St. Lara's, a world filled with hurts and pains for the patients and the few of us who watched these tragedies helplessly.

The Trauma Team.

The night was still and quiet. Hallway lights were dimmed. Every little noise was audible and every movement noticeable. This was very unusual for Saturday night at St. Lara Hospital. The nurses were busy at their different stations charting patients' records. This tranquillity was occasionally interrupted by the heavy wind whistling, hitting the glass windows. Many doors were closed. The patients were sleeping quietly in their rooms. Loud paging was forbidden at such a late hour except in an emergency.

Suddenly, the voice of the female operator blasted through the speakers. "Code blue, emergency room! Code blue, emergency room! Code blue, emergency room! "

Immediately, some nurses jumped up heading for the elevators. The respiratory department team followed. Another team of nurses dragged the defibrillator machine with them. These movements at different parts of the hospital resembled a contingency of soldiers approaching the battle-front. The emergency room was the battleground. Hospital security men subsequently secured the emergency room doors.

On the stretcher wheeled in by the ambulance drivers, a uniformed body breathed heavily. The first nurse approached and tore off the patient's uniform shirt exposing his chest. He was covered with blood. His left face was smashed, the top of his head split open and his nose broken, collapsing to the right. The two sides of the stretcher were dripping with blood. Another nurse removed his pants. Suddenly, his breathing stopped. Quickly, one nurse moved the defibrillator closer to the stretcher while the emergency room physician ordered him shocked.

"Move back! Move back!" the nurse operating the defibrillator shouted as she raised the two paddles above her head. They came down on the patient's chest and a temporary convulsion induced by electric discharge rippled his body.

The other nurse kept pumping up and down on the victim's chest. His electrocardiogram remained flat. No sign of life!

"Give me epinephrine," yelled the doctor, staring at the monitor. He injected the drug intracardially. The nurse continued pushing up and down on the patient's chest. The more the nurse massaged the chest, the more blood oozed out from many bullet holes.

"Give him another shock!" shouted the doctor. "Continue chest massage! Atropine! Valium! Lidocaine!- - - another Epinephrine!"

For forty minutes, the patient did not respond except for occasional activity on the monitors. The emergency room physician called off the code. The door popped open. Joyce, the nursing supervisor, walked in elegantly with a smile as usual. She always came to see the progress of codes, especially in the emergency room. When she approached the stretcher where the body lay, her eyes splashed open. Her smile instantaneously collapsed. She froze, petrified like she had seen a monster. Then she threw the folder in her hand to the floor, bent over and grabbed the body, screaming. Storms of tears poured down her face as her uniform's front soaked with blood. "My brother! My brother! Oh, my brother!" She wept uncontrollably, shaking the young man's body.

Seeing what happened, two nurses dragged Joyce out of the emergency room, consoling her.

"I didn't know that police officer was Joyce's brother!" exclaimed the emergency room doctor.

"I knew he was when they brought him in," said the male nurse sadly.

The outside emergency room door opened, and eight uniformed police officers came in. "Where is he?" shouted the chief officer, looking scared.

"He is dead," the male nurse answered with dismay and pointed to the body.

They took the body, covered with the white sheet stained red, to the morgue. The bad news spread like a fire all over the hospital. Many nurses came to the morgue to glimpse the dead policeman.

There on the stretcher, he lay motionless, covered with blood. His head was twisted awkwardly to the left, his eyes closed, his body cold and getting stiff.

This was the beginning of the horrible experience I had at St. Lara Hospital. Watching people die scared the hell out of me. I could never get used to this. In this hospital it was the routine for the weekend.

Two weeks following that incident, I was working Friday night, an extra shift after my regular evening shift in the laboratory. The time was 11 p.m. when I arrived hoping to have a decent night. I was praying quietly inside me. Maybe I would have some spare time to study. Instead, I was told the emergency room had called the tech on duty. Immediately, I headed there with my phlebotomist's tray. The evening techs had gone home; I was alone. In the emergency room, two patients talked very fast, giving reports to the police officers standing next to their beds. Their clothes were soaked with blood. Evidently, they were victims of a robbery. They were Africa American teachers caught in the wrong place.

As I approached the first one to draw his blood, his head fell backwards to the stretcher. He stopped talking to the police officer and passed out. Then he stopped breathing. One of the nurses jumped up and yelled to others for help. In a minute, all the emergency room nurses rushed to this man's bedside.

I retreated to a safer corner watching the activities going on around the patient. An emergency code procedure was initiated. They were pumping up and down on this patient's chest, intermittently shocking him with a defribillator. From my corner, I saw blood oozing out from everywhere on this man. He was shot more than five times by his attackers. The stretcher was stained with blood and so was the floor. After few minutes, the procedure was ordered stopped by the physician. The patient was unsalvageable. He died.

When this was over, I approached the second victim, drawing his blood. He was very upset because his friend had just died in front of him. I dashed to the laboratory to process the blood specimens. The patient was going to surgery.

Quickly, I did the tests and called the results to surgery, assuring them I had reserved four units of blood for transfusion in case needed. Surgery on the patient had started I was told. One hour later, the surgery nurse came for all the four units of blood available. I was in the lab doing my other work and praying hard for the patient to survive. Two hours afterwards, the same surgical nurse came back with empty blood bags. I was about to yell victoriously for saving this one, but the look on her face above her surgical gown told the patient's fate. In despair she said, "Despite all we did to save the second one, he died too."

Speechless, I sat in a corner crushed and disgusted over the two human tragedies I just witnessed. Sadness besieged me the rest of the night. The longer I worked weekend nights at St. Lara's, the more I got exposed to many gunshots, accidents, stabbings, cardiac arrests and other medical emergency victims. The door to the emergency room never closed. The evening could be quiet except for occasional, hurt-all-over-type of patients. At 11 p.m, the gun party would start. The patients were rolled in on the stretchers to the emergency room by the ambulance drivers. I had seen some quiet nights, but never on weekends.

Many months passed before I could deal with patients dying before me. Just as I was getting used to these senseless deaths caused by our violent streets, other problems inside the hospital started to unfold before me. One evening, a patient in her late fifties would not let me draw her blood. Like always, I talked to her, trying my best to calm her down. She was very upset saying, "Nothing has been done for me since I've been here."

Based on the patient's complaint, I realized I had drawn blood from her at 2:30 p.m. for blood sugar. At 4 p.m., I drew another sample as ordered for blood sugar. But, at 6 p.m. when she had refused, I noticed she was agitated. She sat on her bed sweating and shaking like she was very angry. I went directly to the nursing station after drawing her blood. I examined her chart, looking at the results of her blood sugar levels done hours before. This patient's blood sugar was 325 mg. percent at 2:30 p.m. while normal blood sugar is from 70 to 110 mg. percent. At 4 p.m., it was 400.

"Why is nothing done for this patient?" I shouted at the nurse seated at the station charting.

She got up from her seat, came closer to me and I showed her the patient's blood sugar results from the chart. "We've tried to locate the doctor all evening," the pretty black nurse answered, but have been unsuccessful. We don't have others, so we can't do nothing." She went back to her seat and continued charting.

I returned to the lab not knowing what to do. There must be something somebody could do for this patient, I was thinking. Since I was foreign to hospital policies about patient care, I could not say any more. St. Lara was a delicate hospital. Although most of the patients were African Americans, the administration was dominated by whites. Wrong questions could land me in big trouble since the administrators worshipped their physicians. Quickly without anybody telling me, I realized the issue was not the appropriateness of care but the dollar revenue.

Less than two hours after I talked to that nurse, the patient went into coma. Then she was transferred to the intensive care unit. She died a week later. I was seized with internal guilt. Maybe I could have done something to prevent the patient's death. But I was afraid. Guilt forced me to discuss the issue with Sister Paula. I was very ashamed of myself. I could not easily walk away telling myself it was not my business. Any time I see human suffering I must do something to change the situation, or I am as guilty. This was the oath I took when I graduated from high school: to stop human suffering anywhere I can, making the world a better place.

Sister Paula listened to my story, then asked me to tell her any time I see such a situation again. How could I? I knew she was very close to Sister Kate, the administrator of the hospital. If any physician got angry at me, I could be terminated on the spot. Similarly, some black nurses had lost their jobs. Inside, I was petrified. But l still felt sorry for the poor dying patients.

One evening, I was doing a white blood cell differential count on a slide under the microscope. I saw many blasts which I brought to the attention of my co-worker. Obviously, the patient had leukemia, but we could not diagnose which type. Only the pathologist was allowed to diagnose, but at 3 p.m., he was off duty. Realizing the patient had been there two months before, I pulled her old slide. I noticed the same abnormal blast cells I had seen in her latest slide. Evidently, the patient had shown abnormalities in her cells missed by the tech who read the old slide.

I jumped at the telephone, calling the patient's physician. This time I was very bold. "Doctor, this patient not only has low hemoglobin and hematocrit, she has a leukemia in progress. I can't tell you what type it is, since we are not allowed to diagnose patient diseases, but the patient has many blasts indicating a leukemia in progress. Our pathologist will confirm the observation and give you his final diagnosis tomorrow."

"Okay, thanks," he said.

My action was initiated to alert the physician to the nature of the urgency of the patient's illness. The slides were left for our pathologist to review. Instead of investigating the case urgently, by an order of a bone marrow study and followed by chemotherapy, the physician did what he had done before. He transfused the patient with two units of blood. This treatment temporarily took care of the anemia, but did nothing for the leukemia in progress in the patient's bone marrow. A week following this incident, the patient was transferred to a university teaching hospital. My follow up showed that the patient entered the hospital with disseminated intravascular coagulation (D.I.C.). She died less than 24 hours after admission. She was Mary, a black nurse who went to the same nursing school as my wife. I felt dejected! The prognosis for such acute myelomonocytic leukemia is very grim, but the patient was never given appropriate treatment for a chance to survive.

These incidents at St. Lara started to bother me. I wondered what I could do besides discussing the issue with my wife. I realized how helpless I was to initiate any change in this institution, where politics and medicine operated together. The winner was always politics, controlled by the hospital managers as the patient care suffered.

More Human Tragedies.

Another weekend, a 27-year-old African American male was admitted to intensive care. He had been coded many times more than normal. After each code, following all the chest massaging, his white blood cell count went up. It started from 15,000 to 25,000, normal count being 5-10,000 cells. At the third code his white blood cells count had increased to 35,000. Curious, I inquired from the intensive care nurse what was going on with this patient.

"He's a drug addict! He acted funny in emergency room. We strapped him down to bed since he kept on struggling to get free," said the patient's nurse.

During the fourth code blue, the patient died. An autopsy report indicated he had empyema: pus in the pleural cavity. Drug testing showed no trace of drug abuse. The patient should have been started on an antibiotic drip with a chest tube in place to drain the pus and fluids. None of this was done because the empyema was never diagnosed till after the patient's death. It was too late.

In the same intensive care unit, a physician was treating a patient's low blood pressure with intravenous Levophed, a pressure agent. When the patient developed arrhythmias, instead of using an agent like Norpace, an anti-arrhythmia agent without cardiac depressant effect, he introduced Indera, a beta blocker. The beta blockade of the heart neutralized the effect of Levophed. The patient's blood pressure dropped and he died in pulmonary edema.

A couple of weeks after this incident, a male patient was admitted directly from home to the intensive care unit. He had swollen feet. No physician examined the patient, just the nurses. The attending physician was out of town. The covering physician received the physical manifestation of the patient from the nurse on the telephone. Evidently, the nurse was unaware the patient was in congestive heart failure. The covering physician only ordered Lasix; a diuretic drug which helped the patient to excrete fluid from the body. When he finally arrived, the attending physician, examined the patient, then diagnosed congestive heart failure. Immediately, he added Digoxin to the patient's treatment regimen. While the physician was on his rounds on another floor, news came to him his congestive heart patient had died. This happened less than two hours after the patient was finally correctly diagnosed from the time of admission.

While I was discussing these cases with other nurses in the hospital, I was told about other miseries of patient care. A patient had a breast needle biopsy. Pathological diagnosis reported the patient's breast was cancerous. The breast was surgically removed. Another pathologist reported the removed breast as normal tissue. Meanwhile, the patient was unaware of this error. She was going crazy while recovering at the hospital because her husband had decided to divorce her.

Stories of other incidents were flying through my ears since I started listening to patients' treatment failures in hospital. The administration was supposed to be keeping these secret from the employees. Nat, the brown haired, male head nurse, had stolen drugs from the pharmacy. The hospital administration did nothing about this despite their awareness of the incidents still going on. Emergency room student nurses and orderlies were said to be conducting physical examinations on patients prior to the physician seeing them. When I questioned one of the physicians from the emergency room, he not only confirmed the stories I heard, he told me more. He indicated some male nurses were doing pelvic examinations on African American young ladies no matter their complaints. The patients here didn't know their rights.

"Can't you do something about this?" I asked angrily.

He looked at me like I was crazy, "Here, a white nurse has more power than the emergency room physician. They are the police officers for the hospital. Many physicians left this emergency room on account of these nurses' reports. I want to make a living. We understand the politics of the hospital, so I just ignore many things like other emergency room doctors. What can you do? Truths have no value here in the light of the big ego of the hospital administrators."

I wasn't only disgusted after this conversation, I started to think of ways to make things better for my people. I understood the doctor's point of view. Blacks and minorities have limited job options despite their education. I already knew of many black physicians who were never given opportunities to practice in predominantly white hospitals. Some of these minority physicians ended up working in prisons or public clinics, just to make a living because of the minimum opportunities to work elsewhere. Later I realized that the opportunities for jobs were there for these physicians, but the health care industry was carefully designed to keep some people out.

The more I thought of these situations, the more confused I got. St. Lara was a Catholic hospital dedicated to serving the poor. Why would such things go on without somebody doing something about it? I concluded that the administration was unaware of the these problems. Subsequent incidents proved me wrong.

Determinations.

While I was wondering about what was going on at St. Lara Hospital, I became dejected. I started brainstorming about ways to solve the problems of blacks in this society. Sad events sank my mood, while fantasy about positive things elated it. Realizing the conditions of blacks across the world, I was determined to leave something for my children. Even if I am unable to leave them large wealth, I have determined to give them sound education and strong moral values. Without education, they can't get anywhere. Neither can my dreams be fulfilled without money. Therefore, I decided to work harder, getting money ready for their education, a goal adherent to African cultural values. In Africa, parents are responsible not only for their children's education, but for their moral development as well. They are very conscious of preserving the dignity of the family surname. I remember what my parents told me before I left home for America,

"Always remember who you are, the house you come from and the dignity of the surname you bear. Whatever you do, always preserve the dignity of your surname."

My determination is to work hard to help my children, offering them a better and easier life than I had. Parents helping their children achieve higher education have invested in the human potential of their children. In turn, African culture expects children to give their parents monthly allowances after college. This is social security, African style; the children are their parents' financial security in old age. No wonder African parents treat their children like pieces of gold. In some situations, parents only educate the first two kids who in turn will educate their younger siblings. A strong part of African culture trains the older kids to protect their younger brothers and sisters. In this way respect is handed up. The younger children respect the older ones while all the kids owe their parents much respect. African children don't talk back to their parents. Parents have very powerful control over their children's behavior even in the midst of numerous distractions from their school peers.

In view of this, I had also determined to obviate the socials woes and adversaries awaiting African American children.

Patients' Suffering Continued.

At St. Lara Hospital, situations had not changed for the patients. Learning the politics of the hospital was not as difficult as understanding them or why they existed. The African American nurses, both males and females, were very timid and afraid to do things wrong. The white nurses were very bold.

One evening, I went to draw blood from an intensive care patient. Like always the ward was going crazy with the noise of the monitors of different patients. While sorting my patient's requisitions, I saw a white male nurse approach the female patient in bed eight. He injected an intravenous push of drug into her. Suddenly, the patient responded with a transient seizure-like reaction. She was coded but did not die. On my way out of the hospital when the shift was over, I confronted the nurse. "What did you give that patient, causing that type of reaction?"

"A pressure agent to increase the low blood pressure," he answered nervously.

"Did the doctor order the drug at such a quick push?" I asked.

"But it came back out after injection," he said nervously working away from me.

He must have thought I was a fool. I was bewildered as I walked to my car. The patient died the following day. I was not surprised. Even in dog experiments, a pressure agent is usually given very slowly. A heart in cardiac decompensation needed pressure agent given more slowly. I remembered what happened to my dog experiment when I gave a bolus dose of a pressure agent. The dog's heart stopped. Only manual chest massage revived him. This time, a patient was killed by the nurse while I watched. It was very sickening. I knew if I reported the nurse, I could get in trouble. I was dejected.

Another time, in the same intensive care, I saw another white male nurse choking a black female patient because the patient made him angry.

These patient abuses brought many questions to my mind. Whom should I blame for these malicious acts towards the black race in our own neighborhood? Initially, I blamed the audacious nurses. Today I blame the administration and we the blacks who allowed these evils to happen, including myself. Instead of standing together against abuses and injustice, we stood in opposition to each other. We watched helplessly, scared stiff because of the nature of the people in management.

Gradually, I was indoctrinated into the reality of hospital life. I was originally deluded into believing that patient care was the primary purpose of St. Lara Hospital, like the egalitarian objectives inscribed like stone in the employees' manual. A physician friend of mine told me after the incidents he observed with patient care at this hospital, "If I ever get sick, Yinka, never bring me to this hospital."

I responded with a smile, understanding the reasons for his comment.

Blacks Against Blacks at St. Lara's Hospital.

The problems in the hospital were not limited to patient care alone. Many other crises were going on in the laboratory. The laboratory workers were predominantly African Americans, but there were a couple of whites, some Hispanics and a few Nigerians. The head of the lab was Victor from South America. He treated all of us like his children, caring for and protecting us.

Animosity existed between some African Americans against Africans. The reason was evident: Most of us Nigerians had college degrees while the African Americans did not. They only had certificates from a two year laboratory training program. Consequently, many Africans were hired at higher pay. This made the African Americans angry. I understood their feelings, seeing newcomers do better than them.

Working together was sometimes difficult. The two year certificate holders tried to prove their technical experiences were more valuable than the bachelor's degree. My friend Dipo tried hard to encourage the African Americans to continue their education in college. Some of them later got their college degrees, hoping animosity would stop. After all, we were from the same black race. Why were we antagonizing each other?

"Eh, Yinka, just give me your college degree and I will be fine," said June, a light-skinned African American.

Linda, a friend, called me at work. Carmen, an African American answered the phone but would not let her talk to me. "Why you want to talk to Yinka? Talk to me, but I don't have a college degree like Yinka."

"I want to talk to Yinka. I don't even know who you are," Linda insisted.

When I finally took the telephone from Carmen, Linda said, "Yinka, it's obvious what you said about this crisis between people with college degrees and those without."

I could not hide the disgust from my voice. "I find it intolerable for us blacks to fight among each other just because some have college degrees and others don't. This is the reason why we are working very hard, motivating African Americans to attend college using us as positive role models."

Despite our attempts at encouragement, the animosities continued since only some were able to obtain college degrees. Others failed, and their anger got worse. The stage was therefore set for confrontations between the African Americans and the foreigners. Part of the animosities against us Africans might be justified. Some of us differentiated and detached ourselves from the black Americans. The Africans were trying not to accept the oppressed image the American blacks were subjected to. But to Africans, this is a way to survive in a racist society. To American blacks, it's an insult to their heritage. In response, the African Americans got offended that Africans claimed they were superior to them. Many American blacks have confronted me with this issue. Each time I reassured them we are all equal. But it never changed the atmosphere of animosity against foreigners in this laboratory. In view of this conflict between the blacks, I made a secret pledge and a commitment to fight for the right of all people, no matter their race, origin or sex. How I would do this was another question I could not answer.

I prayed to God to tell me when it was time to make a difference. There was nothing that hurt me more than seeing our people fighting among each other. We all ended up going nowhere. The white folks watched us with amusement while we were busy tearing each other apart, pushing ourselves off the economic ladder of progress. No wonder the society learned very fast that the biggest obstacles to the blacks' progress was a crisis among them.

Every day we live to that dream: the prophecy of failure and despair without realization. This is evident with the rate of crimes in our poor neighborhood, where the economically successful blacks have abandoned the poor ones. A St. Louis publication of an African American business directory implied that, within the black community in St. Louis, we can generate 24,396 jobs, but our inability to see fellow blacks improve make this goal difficult. We have subjected ourselves to the "divide and conquer, house and field slave mentality." This makes it difficult for some blacks to be loyal to their race and in some situations keeps them in opposition to the progress of the black race. We must learn to invest in black businesses, supporting each other since money spent in black businesses comes back to our community. We should learn from the way the Asians do business by working together and helping each other, the report urged.

I was standing in the receptionist area of the lab at the beginning of my shift, consumed with deep thoughts of how to improve relationship among blacks. In sadness, I was wondering about the plight of our people and the dooms ahead.

"Eh, Nigger! You're working in the Chemistry department," said Carmen smiling.

"Don't you dare call me by that ugly name again!" I snapped.

"I'm just playing with you," he said laughing.

"Don't play with me with that ugly name," I said firmly, walking away.

I have always found it difficult to understand why we blacks call each other derogatory names, not understanding the social implication of them. Yet we want respect from other people. We don't even treat one another with respect not to talk of the preservation of racial dignity.

I was very tired when I got home the following morning but a letter from home caught my eyes. It was sitting on the dining room table. One of my brothers had sent me a nasty letter for not sending money to my mother. I had forgotten my personal obligation to her while I was consumed with romantic love with my wife and family. Sadness over-shadowed me after reading the letter because I was guilty. In haste, I made arrangements to send some money home. This time, my conscience reminded me of my original pledge to my mother. Mother's passion consumed me while I thought about many broken promises I made secretly to her. I had not bought her a car, neither had I bought a house. Sitting on my living room couch, I felt ashamed like an ungrateful child. Resolving my guilt, I made a decision to bring her to the United States on vacation.

Hospital Politics and Laboratory Management Crises.

At the St. Lara lab, the administrator in charge was changed. Dr. Philla, the new administrator knew nothing about laboratory operations. This was hinted by somebody in administration's office. He had the job because of his Ph.D. and the right race.

When the new administrator took over, the hospital contract with the pathologist changed. Originally, the pathologist was the clinical director and the head of the lab operations. He used to receive a percentage of the revenue generated by the lab tests. This was stopped by the administration including severing him from the lab operations and decisions about personnel. The power of operations over the lab was given to the lab manager, under the control of the administration. The pathologist therefore had no power over the lab manager except for clinical consultations.

This arrangement was not restricted to St. Lara Hospital alone. It was the new trend in other hospitals across the nation, severing the pathologists from the clinical lab operations. This new arrangement led to management disasters in hospital laboratories as the lab managers clashed with the pathologists in power struggles. In response, the pathologist refused to advocate for the lab in the medical staff meetings. He stopped defending the lab when physicians complained about lab tests. The line of communication between the lab and the physicians was therefore severed. Consequently, the complaints about the lab increased as the department became vulnerable to attacks from other parts of the hospital, especially the nursing service.

The issue here was not whether the pathologist should defend the lab or not. The basic problem was, when a clinician was removed from heading a clinical department and replaced with a non-clinician, the essence and purpose of medicine were defeated.

Today, with new trends to modify health care delivery system, if the hospital process of administration is not overhauled and monitored, whatever system put in place is doomed to fail. Like the old saying; those who fail to learn from the mistakes of the past are destined to repeat them.

Two months after Dr. Philla was appointed over the lab, he removed Victor, a Hispanic from the head of the laboratory and made him the supervisor of the bacteriology department. Victor had headed the lab for over twenty years. I had spoken to Dr. Philla, and he had promised not to remove Victor from the position because these lab complaints were not unique to our hospital.

Mark was brought from outside the hospital and made the new laboratory supervisor. The man had dropped out of medical school after two years. He knew nothing about the operation of a clinical laboratory. When the present day status evolved severing the pathologist from the personnel control of the laboratory, staffing crises also resulted. The administrator and the lab manager team in control of the lab is like the blind leading the blind. How can the people with no clinical medicine education make decisions affecting the practice of medicine? This question was the problem created by the hospital establishment of the '90s. During surgery, the lab is another extension of the surgical team. Without blood preparation by the department, the patient will die in surgery. How then can a non-clinician like a hospital administrator understand the detrimental effect of patient care caused by staff shortage?

Mark spent a few months in the lab before being transferred to the personnel department. Dipo was made the temporary supervisor of the laboratory. I knew he would have confirmation problems because of the animosity against Africans in the lab. He was later reported to the administration by the women from the lab. Whatever their complaints, they robbed Dipo of the job. Eleana, an African American, was brought in to head the lab. Dipo returned to his position as the supervisor of the Hematology and Blood Bank departments.

The day Dr. Philla came to introduce Eleana, he said, "I brought you a woman who is a part of you. She understands your language, came from the same place as you all. She is the new head of the lab."

After he left, Eleana took over. She was elegantly dressed to attract attention. Probably too elegant for the job. She was not attractive, but her make-up compensated for her plain face. Her first speech to the whole lab was unimpressive. The reaction of the laboratory personnel toward her was expected. Many of the women resented her. They protested the administrator's insult about the way Eleana was introduced. If these women would not get along with a black man, there was no way they would get along with Eleana.

When Eleana took over the lab, she made it worse. She was very arrogant, making many black females resent her even more. I remembered a comment made by one of the lab women, "She's so overdressed, makes us look shabby." Her know-it-all approach to technical problems was one of her biggest flaws. Eleana was never a technical person in the lab, except for haven worked in a research laboratory. I did not believe she was qualified to work as a technologist let alone operate a clinical laboratory. She made many mistakes in giving wrong directions, ideas and information to the techs which sometimes contradicted the textbook. She was very hard-headed and never listened to suggestions or ideas. She was always right and nobody else was. The African American women hated her for this. From this and the negative comments from the lab women, I could tell disaster was incubating. I started looking for a safe place to hide.

I continued working as a technologist on the evening shift at St. Lara Hospital and nights at St. Nicholas Hospital. I tried hard to avoid Eleana since I learned of her egocentrism. Her lack of management skills had created more confusion in the lab among personnel. They believed Eleana was often wrong about decisions. Many times they engaged her in heated argument in lab meetings. The majority of her decisions were more detrimental to patient care. One time she ordered us to do a urine culture from a non sterile container contrary to the Bacteriology policy. Another time she accepted non-labeled blood sample tubes from the emergency room. This was against any clinical laboratory's policy. But, this is the price any hospital pays for having the wrong person in management. Dr. Philla should not have alienated the pathologist from lab management even if they removed his lab cut from the revenue generated. It was the error many hospitals across the nation made in the '80s and '90s. This malaise would grow like wild fire in hospitals running the health care to the point of economic disaster.

Another Patient Disaster.

One Friday, I had to work a double shift at St. Lara's lab. At 3 p.m. I was told of a patient on the Three South nursing station who was bleeding into the kidney. Nobody knew what was wrong with him, not even his attending physician. I investigated the case since I would have to handle the patient by myself on the night shift. His urine was red with no visible red blood cell under the microscope.

Immediately I visited him, drawing the next timed hemoglobin and hematocrit blood sample. He was a hefty man weighing almost two hundred pounds. His vital signs were okay, except he was beginning to be lethargic. After I drew his blood, he showed an unusual reaction. He never stopped bleeding from the sight of vene-puncture. I was forced to give him a pressure dressing plus applying pressure with my thumb for fifteen minutes, before he stopped bleeding.

After I left his room, I headed to the nursing station to inquire about his history. Earlier that day, he went to surgery for knee fluid aspiration because he had swollen joints and pains. However, the surgeon burst a blood vessel during the process. From my analysis and immunological background, I had enough information to decide on what could be wrong with the patient. His hemoglobin which started from 15 grams prior to surgery had dropped to 12. As the evening proceeded, it dropped to 10 grams.

Immediately I called the attending physician, telling him about the patient's condition. From our conversation he implied he did not know what was going on with the patient. He had not seen the patient since surgery. I frankly told him his patient probably had developed a case of stimulated hemolytic anemia. "The cause of this condition may not be apparent at this time. But it could have resulted from bursting of the knee blood vessel during the surgical procedure. The sequestered protein entered the blood circulation coating the red cells. The macrophages came in swallowing the red cells, causing a stimulated auto-immune hemolytic disease," I explained to the doctor to the best of my knowledge.

Understanding and identifying the disease with its probable cause was one thing. The survival of the patient is another and depends on the management of the disease. The doctor wanted to transfuse the patient with blood, but all units were incompatible. His red cells were heavily coated with antibodies. I saw a spectacular picture of macrophages engulfing two to four red blood cells at one time. I could not work up the case as I wanted because the lab was too busy that evening. We were short of help. On the night shift I was the only tech on duty. Efforts to convince the administration to give us adequate help had failed. Patient care started to suffer very severely.

Later that night, a revelation came to me from the nurses that the patient's physician failed to give adequate steroid prior to the surgical procedure. He gave a little dose, hardly enough. Steroids will block immunogenic reactions to some extent.

Meanwhile, I had to get permission from the pathologist to release incompatible units of blood for transfusion to this patient. I called our pathologist relating the patient's problems.

"I've never seen a case like this in my life!" said the pathologist. "I can't okay you releasing any incompatible blood for that patient. Whatever you do, it's on your own. Call the blood transfusion reference center for help."

This was the most difficult situation I have ever been involved in as a medical technologist. I could not release the blood on my own because of the lawsuit potential. I discussed the case with our transfusion reference center. They told me the physician should have given a large dose of steroids prior to the procedure. We all agreed the patient would destroy foreign red cells faster than his own due to the nature of the disease. But the patient's physician refused to talk to the reference center. I was the mode of communication between them.

Time was ticking, and the patient's hemoglobin was dropping. He was becoming more lethargic. I was racing against time and a crazy system. I recommended the patient be transferred to intensive care to monitor his vital signs. The head nurse complied immediately. Halfway into the night shift, I knew I was alone in this painful dilemma. I wanted to transfuse the patient but had no legal authority to do so. Although I was not a physician, I wanted to give the patient a massive transfusion preceded by a large dose of steroids or a cytotoxic agent to control the hemolytic disease. That was the only chance we had. Otherwise, the patient faced a poor prognosis.

In the midst of this confusion, I released a unit of blood as directed by his physician with no change in hemoglobin level. Actually, this action was against my pathologist's advice. But, if the patient's physician wanted it, I believed I was legally covered. At 5 a.m., the patient's hemoglobin dropped to 6 grams. My night shift ended at 7 a.m. and I was on my way home, hoping to leave the patient for the day shift. But on my way out, the patient coded. He died. My heart was crushed; I went home in deep sorrow.

The patient died at exactly 7:15 a.m., less than twenty four hours after his illness started. The disease could have been prevented. Although I was not responsible for the patient's death, the guilt of watching him die slowly will stay with me the rest of my life. I wished I was in a position to do something about this senseless death.

The following day, the pathologist was crediting me for not transfusing the patient before a group of lab techs while discussing the case. He told them it was better for the patient to die cleanly, avoiding a law suit against the laboratory. I was devastated! Is this what medicine had come to? Did this patient really die "cleanly"?

This incident and others at this hospital made me begin to wonder about the future of our people. It was a Catholic hospital all right with fundamental values to safe human life. But the health care philosophy was destroyed in the political games of the establishment, and the relentless desire to make money, exploiting the poor people. For quite a long time, I was deluded into believing the hospital's desire was to heal the patients. Lessons taught me the reverse is true. The health care industry makes money keeping patients sick. Consequently, a change in health care today should pay hospitals and physicians for healing the patients, not for keeping them sick like the present situation. When the patient dies, nobody gets paid, except in a situation when death is either predicted or anticipated.

As time went by, I started to wonder how I would bring about changes to St. Lara Hospital. Many times I would discuss the issues with my friend Dipo and other physicians. Everybody wanted to make a living. Rocking the boat was not their idea of making a regular paycheck since they could lose their jobs in the process. Therefore, people maintained low profiles about sensitive issues regarding patient care, and innocent patients continue to die.

Joyce Joyner Tragedy (the Olympic Star's Mother)

What I experienced on my last night shift at St. Lara hospital made me more determined to do something about human suffering, especially for our people. Another tech had taken over the extra nights I was working. This particular Saturday night, everything was quiet, except for minor timed tests ordered from the floor. The emergency room was quiet. This was very unusual for this hospital since gunshot wounds were common during the weekend.

Around 6 a.m., I was sitting by the receptionist desk waiting for my shift to be over. The hallway was quiet except for an occasional nurse bringing her patient requisitions to the laboratory. Some of the day X-tray employees were coming in gradually. A man in a white coat dashed to the lab bringing blood specimens. He was one of the physicians from my home country who worked in the emergency room occasionally. This was unusual because the orderly or the nurses normally brought the blood samples to us.

"Run this Stat! Call me the result right away. This is an employee!" he said in a hurry, dashing back to the emergency room.

Realizing his reaction, I did the test in a hurry and called the results to him. What had happened? I was curious. I did my own little investigation. The story was heartbreaking. It was pitiful.

The patient was Joyce Joyner, a middle-aged woman brought to the emergency room in a meningitis coma. She just left work on Friday at 4:30 p.m. Her co-worker indicated she had complained of feeling sick for a week.

Unlike other employees, she did not want to beg a physician to give her medications. I was of the opinion she did not have medical insurance. She could not afford it because she was putting her children through school. But St. Lara's did not make provisions for employees to get free treatment. If employees could not afford insurance, they just suffered.

In some hospitals, employees get free treatment when sick on the job without insurance. This would encourage them to go back to work instead of leaving for home after treatment. In serious cases, the employees would be sent home. In St. Lara's, the only people with access to free treatment were the physicians and administrators and their families. The poor employees who could not afford to pay were denied free treatments. I thought the Bible teaches us Christians that, "Those who live by the temple, shall eat by the temple," and it is our primary job to heal the sick and have mercy unto them that are in need.

Joyce Joyner was a very hard working mother who had much pride in her job as a nurse assistant. She dedicated her life to putting her children through school. But she did not want to beg any of the arrogant physicians to help her. However, she did not know her situation was critical the Friday preceding the morning she was admitted in coma. At the time of admission, her immune system had broken down irretrievably due to the disseminated infection all over her body. She was a very admirable woman indeed.

The least this hospital could have done was helped the employees when they were sick before it was critical. Understanding the predicaments of poor blacks, we employees started working together. We did free tests for each other, begging some of the physicians to give free prescriptions.

A student nurse came to me one day. Her son was sick. She had no insurance. Secretly she brought her son into the lab. The little boy was not only hot, he appeared dizzy. But his handsomeness still shined through. I will never forget the sorry look on the boy's face, bringing tears to my eyes. We drew the blood, did the tests and gave the results to a physician friend of mine. He gave the little boy medications. He was septic, infected. We all did this favor for each other since there was no rule against it. I could not count how many urine and pregnancy tests I did for the female employees. This was the only consolation I had, helping my people.

But Joyce Joyner either did not want anybody to feel sorry for her, or she was too dedicated to working hard, not realizing how sick she was. Whatever the problem was, only heavens knows exactly. Joyce died two days after admission. This was the first time, hopefully the only time I would witness an employee dying at the hospital as a patient. Some years later, her two children, both male and female, became Olympic stars. I always wondered if they knew how their mother worked hard, sacrificing her life to educate them.

The Laboratory Crisis Escalated.

The laboratory problems at St. Lara got worse. Eleana had started cutting help, causing staff shortages in the lab. Her lack of experience in managing a clinical lab made things worse. She was always in a fight with other women about her policies and style. Just because she was the head of the lab did not give her academic superiority over the entire lab personnel. She only had a bachelor's degree, but assumed she had a Ph.D. She knew everything; you couldn't argue with her. One of her greatest flaws was her ruthless treatment of her fellow blacks. She blocked annual raises for the entire lab. When the employees found out, they were angry.

One day, Ursula, the evening blood drawer, did a free test for her friend, a unit secretary. They forgot to take out the data processing copy. When the copy got to data processing, they called Eleana's attention to the problem. Instead of Eleana warning Ursula never to do such a thing again, she terminated her on the spot. She alleged Ursula was guilty of fraud. Everybody at one time or the other had done a free test for fellow employees. Even Eleana herself had asked me to do free tests for her friend's husband. Why then was Ursula terminated, because the billing department noticed the free test?

Ursula' s termination hurt me not only because she is a black woman and single parent, but because I fought through Sister Paula to get the evening shift a blood drawer. She was our first evening blood drawer from the time Mark was in charge of the lab. Knowing Eleana, who wanted to win brownie points from the administration, she did not replace her. The evening shift's suffering started.

Things did not get better in the lab at the time Dipo wanted to leave. He had obtained a job as the head of another laboratory. His supervisory position would be vacant. The hospital had already advertised the position. Eleana had interviewed many applicants, including Ph.D.s. She did not find a suitable applicant for the job.

One evening Eleana called me to her office. She sat down quietly, looking at me, smiling. I was anticipating what she was going to ask me.

"Yinka, how come you didn't apply for the supervisory position over Hematology and Blood Bank departments?" she asked. "Your friend Dipo will be leaving soon."

"Eleana, I'm not interested in a supervisory job," I said very firmly. "I have two full-time jobs, I'm going to school part-time and I'm getting ready for a Ph.D. program. I am not interested. Please try somebody else."

"Fill this out and give it to me, if you ever change your mind." She handed me a job transfer form.

When I left her office, I tore the form she gave me and threw it in the trash can outside her office. A week later, the same incident was repeated. I told her I was not interested in the job. She gave me another transfer form. I tore it up like before. She did not bother me again for about a week.

My decision to refuse this job was based on my personal convictions. A hospital should be a place to heal illnesses, not generate them. Many patients had died in this hospital needlessly. The way the hospital was set up did not encourage better patient care. It only emphasized making money at the expense of the poor while the employees were working under slave conditions. How could I be a manager in a place of work full of vice? I did not want to be put in a situation to defend the hospital's immoral practices.

On Dipo's final day, there was a send off party for him. I came in as usual at 1:30 p.m, heading for the patient drawing room to prepare for my shift. While I was coming out of the bathroom, putting on my lab coat, Dipo was waiting for me. He sat in a chair with his lab coat, wearing a smile on his round ebony face.

"Sit down, Yinka. I want to talk to you," he said still smiling. "I want you to take that job after I am gone. Today is my last day. Eleana will ask you again, take it. She has not been successful in finding an appropriate person for the job. Please, Yinka, go ahead, take it."

"But Dipo, I do not want the job," I said raising my voice.

"Why not? This is the opportunity for you to change things for the better. You complain to me how bad things are here; now is the time to do something about it. You can make changes like you always wanted. Eleana will ask you again. Go ahead, take the job."

Still not convinced to change my mind, I got up from the chair and headed to the laboratory work-bench. I already understood my agenda to help the poor was different from the hospital's agenda to exploit the poor. How then could I be comfortable working with such a corrupt system? Just as I was stepping out of the door, Eleana came to me.

"Come with me, Yinka," said Eleana, "I need to talk to you."

Speechlessly, I followed her to her office.

"Yinka, I want you for the supervisory job."

"But, Eleana, I told you I don't want the job. Why don't you give it to Gloria? She is a black American, just graduated with a bachelor's degree."

"I'm not sure she can handle the job. She doesn't have enough experience and your qualifications."

"But, I'm going to school. How can I handle a supervisory job, another full-time job and graduate courses at the same time?"

"I want you for the job. You must take it! Get your feet wet," she said very strongly like she was no longer asking me. She was commanding me. "When you make up your mind, then your salary change will be effective onward. The longer it takes you to accept my offer, the longer you will be without salary differential."

I left Eleana's office very unhappy. I was being forced into a situation I didn't want to be in. Being a supervisor in this hospital was the last thing I wanted to do. I was wondering about the legality of being forced into a job I didn't want. Everybody else had the right to choose their job position. I was forced and threatened. At this time, I knew my options were limited.

Another reason why I had refused the job was an anti-African movement in the lab among American blacks. How could I supervise people who hated me because I am a foreign black? How could I survive in an environment of hostility because I had a bachelor's degree and was earning more than them? Part of the reason why the lab personnel were angry was the administration treated them

like the second-class citizens.

The nurses were treated better. Eleana's managerial skill was like some health care managers today: very poor, tinted with arrogance. She used to call the lab employees "have nots." She elevated her social status higher above them. They were her blood and flesh; blacks from the same environment. Eleana's behavior is typical of some financially successful blacks today who alienate themselves from other blacks because of their superiority complex.

At this time, the lab crisis was heightened. Complaints had increased against our department, both from the medical staff and the nurses. When I became a supervisor, the few African Americans who liked me started to hate my guts. Without anybody telling me, I knew I was in deep trouble. It was like jumping in the middle a stormy weather. Why should I blame them? Even though they knew I am black, they considered me a foreigner doing better than them. Quickly, they detached themselves from me and started to oppose anything Eleana asked me to do. Dipo was able to keep crises down because he had supporters among the women. I had none. It was the beginning of a nightmare.

Among this group of women were complex personalities. Brenda was the one I admired in the group. She did not have a college degree but was much more of an adult than the rest of them. She was never explosive emotionally but dealt with problems with reason. I did not have many problems with her. Although she wanted to help me many times, she became defiant because of co-workers' pressure. Brenda was married with children. She worked in the Blood Bank unit of my department. She was in her early forties.

Lula was another female in my department. She worked primarily in the Hematology unit. She was in her mid-forties and very emotional, unlike Brenda. Usually she was very calm and remained cooperative until goaded into an emotional fireball by her co-workers.

Jo Ann was one of the troublemakers in my department. She claimed she knew more about Blood Bank than anybody else. Yet her brain and emotion were impervious to human reasoning. She remained quiet and expressionless but would constantly be initiating trouble underground with co-workers. She was in her late forties.

Laura and Mary were the biggest problems I had in the departments. They were highly explosive and ready to fight, yelling and screaming anytime in disagreement with any issue. Laura was very emotional partly because she was a single mother, physically abused by her boyfriend. She was usually controlled by Mary, the powerhouse of crises in the laboratory. Mary was always a walking time bomb, a collection of emotional explosives. She could go off any time, creating disasters for others. She always derived pleasure from any heightened emotional crisis and its outpouring of adrenaline flow. Mary couldn't afford to remain still. Tranquillity was her enemy, peace would always bring her boredom and orderliness initiated her discomfort. One day, when everything was going fine in the department from 8 a.m. to noon, she decided to initiate trouble. She said, "I think there is too much peace here. We need to start some confusion."

The rest of her co-workers paid no attention to her. I overheard her from my office, but pretended I did not hear her. Realizing nobody paid her comment any attention, she went to the Chemistry department. By 12:30 p.m., Mary had initiated a giant crisis in the Chemistry department. The Chemistry women had responded to her over a disagreement on a policy. The out-pour of adrenaline flow had reached my department, setting off a giant argument in motion among my staff. There was no more peace or orderliness. The women had gone totally nuts! I sat in my office praying they would not involve me in their disagreement. This time I was lucky. Most of the time, I was their center of disagreement.

For the most part I could understand their frustrations. They were unhappy because of years of oppression by the administration. The white-controlled establishment never catered to their needs, offered job incentives or gave them any recognition. They were the object of persecution by other departments in the hospital, especially the nurses. For years they had no opportunities to make their opinions known to the administration, until when Jackie, an African American, became the personnel director. It could have been an opportunity to improve things for blacks in this institution.

She could have made the opinions and the complaints of blacks and minority known to the hospital administration. The administration's response to these problems could have decreased some tensions in the laboratory thereby encouraging peace and harmony among workers. Jackie's response to employees' complaints from the lab supported and reinforced her animosity against foreign blacks. The laboratory personnel crisis intensified, this time, involving the administration.

At that time, I knew the stage was set for heads to roll in the laboratory. What I thought would be a break-through to the administration became a crack-hole in administration to total disaster as African Americans turned against Africans.

Understanding the trouble I was submerged in, I started bringing donuts to work for my department. I continued the coffee club I started on the evening when I bought most of the ingredients. I gave special presents to any of my staff on their birthdays. I was hoping this would quieten them down. It only had a temporary effect.

Realizing the problems in the laboratory, I initiated a Christmas party to bring all departments together. I did this partly to help Eleana since animosity against her had increased. My plan worked. I joined hands with other supervisors to give Eleana a present. Nobody objected. Mary, the biggest troublemaker, was out of town for Christmas. Boy, was I glad. We were hoping everything would be fine without her.

On the day of the party, I was in Eleana's car on the way to the grocery store to buy meat trays. I was a little nervous being the first time in her car and not knowing how to start conversation regarding the tense situation in the lab. Suddenly, I decided to be bold. We were on the highway to Fairview Heights. Then I started speaking, "Eleana, you know I have heard rumors about your removal from office."

She looked at me from the driver's seat with a seductive smile as if I just made up a fictitious story or made a pass at her. "Yinka, I wouldn't worry about that. I've heard the same thing. I inquired from Sister Kate and she said it's only a rumor. There are rumors floating around about other departments too."

"So, you don't realize employees' resentments against you in the lab due to staff shortage and your way of doing things? I believe trouble is brewing in the laboratory."

"I'd not worry about that if I were you," she said with a devilish smile and confidence in herself.

At Schnucks, we collected our meat trays and headed back to the lab. The Christmas party worked well. We had raised the techs' morale. Eleana was given a surprise present of a clock I had purchased with the donations from all the supervisors. Since the techs had tried to turn me against her, a joint supervisors' present would be a symbol of our support for her.

The following Monday, Mary came back from vacation. When her friends told her of the party in her absence, she ignited another crisis in the lab. Sadly her collaborators had no conscience of morality or human decency. She had enjoyed for years her ability to argue till her blood pressure went up. Then, she would report to emergency claiming somebody made her blood pressure go up. One time, I made the mistake of inviting them to my house for a party prior to becoming a supervisor. The party was prompted because of my narrow escape from death in an accident that almost claimed my life.

It happened on a day I had left St. Lara's feeling dizzy because of sick-building-syndrome. In the lab, I suffered headache and dizziness due to poor ventilation. I had reported it to Dr. Philla. He did nothing about it. On this particular day I left work and lost consciousness momentarily in my car on the highway. I ran into a stationary car. My car was a total loss. Because of this, I decided to have a party bringing my fellow workers to my house.

Mary started a big argument with co-workers because Naomi wanted to bring her daughter. Besides my praising the Lord for surviving the accident, I wanted to use the opportunity to bring blacks together. This was one of the greatest mistakes I made including bringing my wife's Mercedes Benz to work the day my car broke down. What I was told the administrator said was not pretty. It was clear the hospital administration was not happy with me.

Later developments indicated the administration believed I was greedy working two jobs and going to school. I didn't sell drugs or rob anybody or banks. I went to college and was educated. I was working hard to live the American dream. Yet, I became a target of persecution. I guess the American dream is not for everybody.

Mary later intensified her negative campaign against all supervisors in the lab. She had joined hands with some of her friends in the lab to report all supervisors to Personnel and the administration. When the first investigation started I knew I was in trouble, but I survived. The second investigation was more vicious.

Eleana had already run the lab to the ground due to her lack of experience. She was the center of the lab employees' complaint. An investigation was in progress by Sister Kate, the chief administrator, to evaluate how Eleana was running the lab. She was the product of Dr. Philla, also an inexperienced administrator of the hospital.

When an unqualified person makes error of personnel decision, their inability to spot those errors let alone correct them is based on ignorance. Meanwhile wrong personnel decisions are costing the hospital establishments millions of dollars yearly. For example, when an egocentric manager gets angry at an excellent worker over a minuscule incident, or personal things, the worker sometimes loses his job. In replacing this type of worker the establishment spends twice as before, hiring two workers. Yet, the quality of work and production level were not as high compared to the previous worker's. This, I learned, is a big problem in many hospitals.

I was told of a case in which a good nurse was given a bad evaluation because her head-nurse told her, "I don't like the group of women you have dinner with." When the nurse refused to change her dinner company, she received even a worse evaluation from her headnurse. In response, the nurse got angry and quit the hospital entirely.

In another situation, one excellent cardiac nurse was interested in a physician. Her supervisor was also interested in the same man. The supervisor confronted her to stay away from this physician. The competition between the nurses heated up. The staff nurse got angry and called the supervisor's husband, reporting her affairs to her husband. When the supervisor found out what happened, she fired the staff nurse. A sexual harassment charge was filed in the hospital against the nursing supervisor. The hospital terminated the supervisor, and the staff nurse also lost her job, disrupting the management of the nursing cardiac unit for three months until replacements were found.

In Eleana's situation, her ignorance had created many problems in the laboratory. She had fired the only night tech, laid off all our receptionists, transferred our lab aid to the housekeeping department and terminated the evening shift blood drawer. Why was Eleana so adamant in not understanding the problem she was creating for the laboratory? Her intention was to please the administrator who hired her. The welfare of the employees and the quality of health care were irrelevant.

Many times, I spoke to her about the lab coverage problem her decisions were creating. She refused to listen. This had always been a major problem for Eleana.

Initially, the techs tried to turn me against her. I refused, sending warning signals to her. She would not listen, being oblivious to realities of things around her. I wanted to help her because she could not see the crisis around her.

One day I went to her office. I remembered this well because it was a payday. "Eleana, can't you see the problems of coverage your decisions are causing in the lab?" I asked her.

"What problem?" she asked smiling like she was plotting a trick only she understood.

After a while, I stopped talking to her, knowing she could not comprehend, nor understand, the monumental crisis unfolding before her.

One day, she called all the supervisors to her office. She needed help to cover the night shift since she terminated the night tech. I could not understand how she planned to cover the night shift effectively. Paul, the Chemistry department supervisor, suggested I work a couple of evenings while Carmen worked some nights.

I didn't like this idea, since it would affect my other job adversely and my sleeping schedule had to change. My body didn't adapt well to changes of sleep patterns. The supervisory stress had started affecting my health adversely. I had worked with many women in my life, but working with these was a problem. I learned very painfully to exercise patience in the middle of a lot of aggravations. It was like trying hard to preclude emotional explosion while your inside is roaring with anger; a form of emotional torture.

Consequently, I did not sleep well anymore. I was constantly under stress, losing twenty pounds in three months. The job headache was becoming unbearable. The poor ventilation of the lab did not help either since these women loved to smoke in the department, inconsiderate of others' feelings. The smoking made my headache worse. Sometimes I got relief after leaving work, breathing fresh air from the outside. At the time I had to work evenings, the staffing was cut very drastically. Instead of four techs and a blood drawer, we were only down to two techs.

I worked the first evening. I was assigned from noon to 10 p.m. My headache got worse due to insomnia and the heavy workload for two people. We were so busy I could not eat. I started to feel dizzy. I endured it. Explaining this to Eleana got me nowhere. The second day, the same incident repeated itself. On the third day, my health deteriorated; my headache got worse, my tonsils were swollen and I was very unhappy. I later discovered I had a strep infection. Instead of calling in sick, staying at home to rest, I decided to ignore my body's warning. I went to work due to my loyalty, which later drove me closer to disaster due to self-imposed stupidity. I thought I was being loyal to the system, little did I know that the management had a hidden agenda to destroy me! When you are too close to a situation, it is sometimes hard to see things clearly.

The stress of supervision forced me to drop out of school. The job only added forty cents to my hourly salary but forty dollars an hour worth of aggravations. Dealing with our people on the job had not been easy. We didn't get along. This is part of the major indications of our economic backwardness as a race. All these problems in the lab had not involved a single Caucasian, except the administrator. Eleana was putting techs in less than humane conditions to work, just to get praise from the administration who underestimated the effect of staff shortage on the quality of health care. The techs in turn resented her even more. She lacked managerial skill.

Getting to the lab on this fateful day of my third time to work this difficult schedule, I approached Eleana. I told her I was sick with headache, dizziness and sore throat. Never could I forget her body language in response to my complaint on this infamous day. She looked at me up and down with a smile, like a woman in hot erotic desire, plotting something mischievous or waiting for the next man to attack. She threw her fat behind in my view, swinging as she walked away, saying nothing. Her body language was not as offensive as her callous response to my illness. This was a black woman treating her follow blacks with indignity.

I worked from noon to 10:30 p.m. that night very sick. At one point I thought I was going to pass out. I was having a horrible headache with dizziness. In addition to the regular work on the bench, covering the Hematology and Blood Bank departments and drawing blood, I was also doing my supervisory duties.

Around 8 p.m, Eleana called, "Yinka, Carmen who is supposed to work night shift called in sick. I am trying to get in contact with Mike, the evening supervisor. He should be coming to cover the night shift."

"Eleana, I am very sick, I haven't eaten all day, it has been so busy and I am presently having headache and dizziness. I am very sick."

"Okay, fine," she responded.

The first two days, I called Eleana to bring us food since none of us had time to eat. Jessy, the Indian lady working with me, was able to sneak out of the lab to eat briefly. I could not leave to eat. Eleana did not bring any food to us those two days, and we suffered. This was in my mind when the phone rang the second time close together.

"Yinka, when you leave tonight, be sure the lab is covered. By 11 O'clock, Mike should be on his way to cover the lab," said Eleana.

"Fine," I said not knowing it was a set up. At 10:30 p.m., understanding Mike was on the way to cover the lab, I went home leaving Jessy to cover the lab for only thirty minutes. Based on my understanding, Jessy was capable of handling the whole lab because Eleana told me earlier that everybody on evening shift was cross-trained in all departments.

When I left the lab for home as sick as I was, I believed I would be called if there was any problem. I was never called; therefore, I thought everything went well. I narrowly averted accidents three times on my way home because I was so dizzy.

The following Monday, Eleana had conspired with the new African American personnel director, Jackie. This was later related to me secretly by someone in administration. I was suspended pending termination for inadequate coverage of the laboratory, although she was the head of the lab who knew all what was going on. Despite the awareness of Mike; the evening and night supervisor of the whole incident, I was held accountable for the coverage of the lab for all shifts. Feeling emotionally devastated was an understatement.

During my ordeal while waiting for the administration's final decision on my appeal, I had contacted some people to help me get my job back. I contacted Sister Paula who was very shocked about my suspension, knowing my excellent record at the hospital. She said, "Tell them of your good track record here!" Sister Paula believed in honesty, but she was as oblivious to the reality of the hospital's politics as I was.

She went to the personnel office, investigating my case. She wanted to know what happened. Being very unsatisfied with the information Jackie gave her, she went to Sister Kate, the executive administrator, who was supposed to make the final decision about my case. Sister Kate had gone to Chicago with other nuns. I was supposed to wait till she came back, giving me some hope.

My case was already reviewed by Dr. Philla, the administrator in charge of the lab. I knew I had no chance with him since he hated foreigners. I had sent some physicians to talk to him, but his hidden agenda dominated his choice. It was this same ulterior motive that led to the removal of Victor as supervisor of the lab, instigating the department's crisis.

Sister Paula had treated me like her son all the time I had known her. She gave me hope my case might have a chance with Sister Kate. With this, I was waiting impatiently in my living room, looking through the slots of the blind, expecting the mailman.

Although it was about 3 p.m, the weather was cold. Our street was deserted since our neighbors had not returned from work. The only things visible on the street were the dried leaves, blown by the quiet wind. Suddenly, the mailman appeared in his little jeep, putting some letters in our mailbox. My heart started beating fast. I got up from the couch, very nervously.

Cold as it was, I had no coat on. Emotion had overpowered my thinking. Just as I opened my mailbox, I saw the pale brown envelope from St. Lara Hospital's administration. I knew the verdict was in for my job. Quickly, I separated the envelope from the rest of the mail.

Inside my living room, all my emotional energies were working beyond human endurance. My heart was racing beyond what I could bear. The intensity of painful anticipation was driving me insane, not knowing the verdict in the letter. I went on my knees praying to God to give me strength to handle whatever the verdict would be. I sat back down, picked up the brown envelope, and quickly opened the letter to be faced with my ultimate fate. Sister Kate terminated me as the Blood Bank and Hematology supervisor on Feb. 4th, 1985. According to her letter, she said, "After considering your case, your illness was well established to me. It was not an issue. The primary issue was whether the lab was well-covered on the night you left."

Initially, I sank to the couch with unbearable despair and humiliation. Was Sister Kate a nun or a nuisance? Tears washed down my face. Holding back tears at this time would be inhumane. It was emotion that had been bottled inside me for a long time. I felt like crashing my head against a concrete wall or jabbing myself with a knife. My heart was crushed beyond what words could describe. I felt betrayed and physically raped by Eleana. How could she have done this to me?

The answer was very blurry to me. Nothing in the world meant anything. I felt empty and hollow, looking for any reason to stay alive in such a hateful world, this mysterious place filled with tears of sadness, agony of despair, sorrow of failures and melancholy of disasters. It is a place of insanity where people try to make sense from nonsense, where crooks always blow their trumpets triumphantly over their conquests of the poor, weak and oppressed. It is a world filled with the confusion and contradictions of the purpose of human existence.

Despite all these thoughts going through my sorrowful mind, the pain of despair was not easier to bear. I was totally lost in the middle of storm. The incident was like a baptism of fire which would impact my life for a long time. Realizing my emotional state, I started to pray knowing it was the easiest time to go astray. The prayer gave me strength and kept me from crashing.