Ailing pharmacist recalls lax chemo precautions

Karen Lewis knew what the possibilities were when her routine medical exam returned an abnormal white blood-cell count four years ago.

"I worked in a cancer center," she said. "I knew."

The longtime hospital pharmacist, now 57, was soon diagnosed with a precancerous blood disease called myelodysplastic syndrome. Her doctor immediately ordered her to stop working with or around chemo agents.

"I started working with chemo in 1993," said Lewis, an employee for years at the University of Maryland Medical Center in Baltimore. "Back then, there were much less restrictive policies (for handling chemo)."

Her attitude then was similar to those of many of her peers.

They had been advised to wear "chemo protective gowns" made of heavy paper, with little cuffs, and double gloves.

"But nobody really did (wear double gloves) because it made it hard to manipulate needles," she said. "And no one said if we didn't follow (the guidelines) we were at any greater risk."

She also doesn't recall being advised to wear a mask.

"My thinking was, if I don't actually stick myself or spill on skin, I'm OK," she said. "I never thought of any other way (it could be) adversely affecting me."

In particular, she never realized that the type of "laminar flow hoods" the hospital used — the commonly recommended type at the time — blew potentially contaminated air back in her direction.

The hood has since been recognized as a safety problem, and a different style of hood — one that directs air away from the pharmacist and out of the room — is recommended.

Since Lewis' diagnosis, she said, the pharmacy where she worked has tightened its controls and upgraded its safety equipment to more advanced technologies, with more containment features and more tightly controlled ventilation.

Lewis has begun transfusions to try to keep her cell counts normal. Ultimately, her only hope for a cure lies in a bone-marrow transplant.

In the meantime, she hopes other institutions will upgrade their safety equipment and training for workers. And she advises others to be vigilant about cancer screening if they've worked with chemo.

"Now, since I left, everybody who works with chemo has to have a blood test once a year and urinalysis," she said. "Maybe that was my contribution."

— Carol Smith