Five Quarts_ A Personal and Natural History of Blood - Bill Hayes [63]
Every specimen that enters this facility is stripped of its identity, Dr. Winger tells me. Each vial is bar-coded, and its every move through the lab is monitored by computer. This makes for the easy and accurate assembling of test results from many machines. The computer does not make mistakes, he states evenly. It strikes me that the whole process is, as much as possible, devoid of human touch and emotion, but also of human error and carelessness. Unbidden comes the memory of that letter Steve received from his previous lab with the news of the phlebotomist who’d reused needles. But I’m comforted by all that surrounds me. His blood’s in good hands here, during this part of its journey, just as he himself is with his regular IDL phlebotomist, Rosemary.
Pausing for a moment in the center of the lab, Dr. Winger quickly points out some of the noteworthy machines around us: “This is an ELISA reader, Western blots here, blood chemistries over there. Immunochemistry stuff. Urinalysis. Blood coagulation panels. Over there is the DNA synthesizing machine, which is synthesizing as we speak.” Across the room, that’s an ultracentrifuge, a device for spinning plasma at superhigh speeds—“It’s forty thousand times gravity in that thing”—a process that separates the component parts of cells.
Amid all this expensive high-tech equipment, I spot something familiar. “That looks almost like a microwave,” I say.
He grins a you-got-it. “There’s nothing better than a microwave for making basic heat-dried stains,” he admits. “It’s the only thing here under a hundred dollars.” This last bit he adds with an air of amusement. They’d just had to send back a quarter-million-dollar piece of equipment that had turned out to be a real lemon. Go figure.
As I follow Dr. Winger toward the last stop on my tour—the T cell tabulator—my mind wanders backward. T cell counts, unlike, say, the newer viral load tests, have been the through-line of Steve’s long life with HIV, albeit a through-line with peaks and plummets. Of the various T cells counted—helpers, killers, and suppressors—the helper T’s are the most important indicator of how your immune system’s doing in fending off the virus. In a healthy person, a normal helper count—often simply called T cells, for short—could be as high as eighteen hundred per cubic millimeter of blood; in a person with advanced HIV disease, it could be eighteen, or zero. Falling below two hundred is the criterion for an AIDS diagnosis. This truck hit Steve in the summer of 1994. Following that, he had to get T cell counts every four weeks as his immune system continued to deteriorate. Watching those numbers descend was a helpless feeling, since Steve had already done every antiviral available and the next wave of meds, the protease inhibitors, was still a year off. It was like he was stranded in the desert and could only watch as his water supply fell.
In the early years of the AIDS epidemic, T cells—as well as all blood cells, for that matter—were counted by hand. In my head I pictured row upon row of white-coated lab techs, all hunched over microscopes, quietly tallying cells with calculators, and all, in a curious casting choice, middle-aged women. The row of ladies who tallied T cells looked more beleaguered than the rest, I imagined. I actually worried about them, faced day after day with the blood of the very ill. I hoped they gave out a private hoot when a robust sample came through. In some parts of the world, these kinds of counts are still done manually. During a recent tour of an AIDS clinic in Rwanda, a friend told me, he