‘Invisible heroes’

Writer's note: my mom, laboratory QA safety specialist at the state lab, used to walk my sister and I through the halls and different components of the lab when we were little. I thought Debbie was the coolest woman then, especially after I started hearing about all the ultras she ran, and still feel that way now. I used to babysit Jeanne Lee’s kids and she fixed a prom dress for me once, and last year we had Joy and her boyfriend over for Thanksgiving. The bond between these women at the lab is truly unbelievable. Even as a kid walking through that lab, I could feel it. I’m so proud to write this story and know these women. Thanks to you all, and I love you, mom.

If you googled Deborah Gibson’s name, you might come up with her title—the deputy laboratory director and laboratory system improvement supervisor—in the laboratory services bureau with the Montana Department of Public Health and Human Services (DPHHS), or you may find her winning times from countless ultra-marathons she used to run basically every weekend before the coronavirus.

These days she tries to get out for 20 or 30 minutes if she can and saves longer runs for Sunday afternoons and Mondays, her time off, if she feels up to it.

Gibson remembers the first few cases of Covid that came to the state lab vividly. “Ever since then it’s been like a constant whirlwind,” she said. In the early months of the pandemic, the lab scrambled to get everything in place. At first, the state lab was the only lab certified to run Covid tests in Montana. Panic was in the air as they went from a handful to hundreds of tests and did not have the proper infrastructure to support the volume.

A large part of Gibson’s job was answering questions from clinical labs about how to collect samples and how to deliver them to the state lab. “I was honestly on the phone probably starting from five in the morning to midnight,” Gibson recalled. A resourceful system including highway patrolmen, state gambling division employees as well as the courier system already in place helped connect the dots between more remote portions of Montana to the state lab.

“We thought we were prepared. You think you’re prepared, but you don’t know what you don’t know. We had no clue that it was going to just explode like that and then never end,” she said.

“It does feel overwhelming almost every day,” Jeanne Lee, clinical laboratory specialist, said. If she is scheduled to work an early shift, she has to steel herself before encountering the boxes of Covid tests in the loading dock.

Gibson took to calling her employees the ‘invisible heroes.’ She thought it was interesting how so much of the conversation surrounding the coronavirus centers on testing, but so little of it focuses on lab workers. They are first responders, she said, but are rarely recognized that way.

Each morning, the lab loading dock is filled with 4,000-6,000 tests in Styrofoam boxes, dropped off by couriers, mail service or hand delivery. Lab workers bring the boxes into the accessioning room where they are numbered and put into buckets for lab technicians who start the specimen extraction.

Each test comes with a requisition form that provides the name and date of birth of the patient along with other information pertinent to the case, such as date of exposure or if the patient experienced symptoms.

All of the requisition paperwork must be hand verified before being scanned into the Laboratory Information System (LIS) to ensure accuracy. From here, results for a patient with verified paperwork can be sent to the facility that ordered the test.

Boiled down, accessioning is the process that each of the thousands of samples the state lab receives has to go through before testing can proceed.

“Sometimes I think people think that we just get it and stick it on an instrument, and it’s way more complicated than that,” Gibson said. Both Gibson and Lee felt accessioning was the most time-consuming and underrated part of the process.

The learning curve the lab went through was steep and swift. At one point running 100 tests per day was a struggle, Gibson said, but thousands are the new norm.

“When we first started, we were doing longer days,” Joy Ritter, developmental laboratory scientist, said. Now, they can do 800-1,000 and be done in eight hours.

“We’re just constantly trying to figure out how to make it easier,” Lee said.

Lee works on a machine called the Panther which serves as one testing method for Covid RNA—what the state lab tests for to determine if an individual is infected with the virus. Several people are trained to work on the Panther to spread out the workload and fatigue of doing the same thing each day.

Lee also performed the verification process on antibody testing so it can be used officially in the state lab. The antibody test determines whether a person has an immune response to the coronavirus. Lee expects it to be used more as vaccines are administered. The test has the potential to detect if a person developed antibodies in response to the vaccine, which would indicate an immune response to the vaccine itself, essentially verifying that the vaccine worked.

Ritter rotates between pipetting samples into a well plate and running tests. It is the monotony that gets to her. “That’s the worst thing about it for me is that it’s the same thing every day, day after day. My job used to be so much more interesting,” she said.

She went from sequencing bacteria, looking at genomes and running other molecular tests to suffering from repetitive stress injuries in her hands caused by opening vials and pipetting day in and day out since March. She notices the weakness developed when trying to open a jar of mayo at home.

“Right now, I’m pursuing treatment, so I don’t have long-term issues. I love to ride my bike and I want to be able to hold onto my handlebars,” Ritter said.

Gibson worries about these repetitive injuries and the mental health of her employees. Not one to focus on the ‘doom and gloom,’ Gibson sends thankful emails and remains positive to keep morale high.

While Ritter’s job pivoted entirely to Covid lab work, the state lab continues to do its regular tuberculosis testing, other infectious disease testing and newborn screenings. “We are still doing all the work that we did before the pandemic started, and that’s all still very important work,” Lee said.

“They rarely complain, and they keep doing what they are doing regardless, because they are passionate about their profession and know that they are helping the communities in Montana,” Gibson said of her team. “They are the main reason I come to work every day.”

Without the bond between lab team members, she laughed and said people would have probably walked out by now.

“You look forward to the little things,” Lee said, like getting to have pizza for dinner.

The people in the lab are working for the people of Montana, but it is their coworkers’ faces that they see every day. The effects of the pandemic are etched in those pipetting, standing hunched under a negative pressure hood, responding to countless emails because they do not want anyone to feel like they are being ignored, and listening to patients cry over the phone because they are so worried about what their test result may mean for them and their loved ones.

Ritter reminds herself of the importance of her work to get through the tedious days. “Somebody’s got to do it, and we know how,” she said.

“My coworkers, they’re really flexible and they cover more than one department and they come in early and we work long days, and sometimes it means skipping our breaks and skipping our lunches,” Lee said. “I’m really proud for our team because they’re so hard working and they’re really working hard for the people of Montana.”

“We have a great team and I’m not kidding. They genuinely care about each other and they’ve stuck together through this whole thing. Even though it’s hard, everyone’s tried to keep a great attitude. We realize the important work we’re doing even though we’re not always recognized for it,” Gibson said.