Barbara Caldwell knows a mystery when she sees one.

And she sees one every day.

The Lisbon resident's official title is administrator of clinical laboratory services at Montgomery General Hospital, in Olney. But Caldwell shortens that lengthy title: "I'm a detective. I'm a problem-solver."

Specifically, Caldwell's staff of 75 analyzes tissues, blood and other samples taken from patients looking for clues to disease and injury. Are white and red blood cell counts in sync? Are cells abnormal? Are chemical imbalances that indicate certain diseases present? Is the patient's body chemistry consistent with his or her symptoms?

"Some of the samples are pretty clear-cut," the Ohio native explained. "Sickle cell anemia, mononucleosis -- those are obvious."

But for Caldwell, part of her job satisfaction comes from figuring out the situations that aren't so clear-cut, that a computer can't interpret, but a skilled human can. When she and her staff can put a name to a disease or a condition after a patient has spent months going from doctor to doctor looking for answers, "we can help with that answer."

"It's all critical thinking and problem solving," she noted, and in a digital, computerized world, it still means preparing the same glass slides many of us recall from high school science, and peering into a microscope (albeit a microscope significantly more powerful than the instruments in a typical high school lab).

"If you like solving puzzles," she added, "this is the career for you."

Although nursing shortages "have gotten all of the attention," Caldwell noted that, "there's just as large a need in hospital labs." A clinical assistant professor at the University of Maryland School of Medicine, in Baltimore, Caldwell has seen class enrollments "drop every year," which surprises her because a good lab technician "can get a job anywhere."

Many of them have gotten a job because of Caldwell. As a college professor for nine years, the Ohio State University and University of Maryland graduate, has taught hundreds of laboratory technicians.

"I can walk into any lab in the Baltimore-Washington area and know someone," she said. And she loves the number of students she's taught that share her enthusiasm for the field.

"It's very rewarding," she noted, "to be present and somewhat responsible for the 'ah-hah' moments."

That passion, she added, extends to the hospital's patients. One of the reasons she's always worked in hospital labs, rather than free-standing facilities, "is that here I feel more connected to the patients."

Because Montgomery General Hospital's facility "is fairly small," as is the lab, "I have a lot more interaction with the patients and the staff." If a phlebotomist isn't available when a doctor wants blood drawn and tested, for example, Caldwell or one of the other lab employees will leave the lab and take care of it. Occasionally, she's even part of the conversation between the patient and the doctor.

The conversations she prefers, of course, are the ones where lab results have ruled out the more serious possibilities for a patient, leading all concerned to breathe a sigh of relief. Sometimes, though, the news isn't good -- it can even be devastating -- which is one of the reason why the lab double checks results to try to prevent "false positives," where someone is mistakenly told he or she has a disease or medical condition.

"I know what happens when people receive certain diagnoses," she said. "I would never want anyone to have to deal with that anxiety because of a misdiagnosis."

Just as patients can have their imaginations begin to race when told of the possibility of certain diseases, so can Caldwell's. When her children were younger -- her daughter is now a second year resident studying to be an OB/GYN, and her son recently graduated from high school -- Caldwell would sometimes, knowing what her children's lab results could mean, imagine the worst.

"A little knowledge was a dangerous thing for me," she laughed. "Ignorance really is bliss."

On the other hand, her knowledge can often save her time in a doctor's office. Unlike most patients, "who are going to the doctor to see what their lab results are," Caldwell walks into a doctor's office "knowing what the lab results are and usually what it means."

What the lab has meant for Caldwell, among other things, is that she has weekends off for the first time in her life. When she started as a medical technologist in 1978 she was on a staff that rotated weekend duties. It's only been since 2001, when she took her current position, that she could make Saturday or Sunday plans with any confidence that she'd be able to keep them.

Not that she has a lot of spare time. Caldwell constantly advocates for her profession, imagining the day when a doctoral degree is available in the field (she has a master's degree) because of the increasing skill level her profession is requiring. She sits on a number of professional committees and other groups, and is evangelical about her profession, and the lives it can touch, to new students, experienced folks returning to the classroom, and other members of the medical profession.

What she tries to tell them is how satisfying it is to take a variety of lab results from blood, tissue or other bodily fluids, and weave them together into a diagnosis.

"About 80 percent of the lab work" is routine, she said, with little question about the results, but some require as much time thinking as they do looking through a microscope or analyzing a computer printout. Some diseases and medical conditions, for example, are rare enough so that it might be years between the times that the lab sees them.

"Probably every day," she said, "we see something out of the ordinary." Some of the time, such as when the lab discovers that a baby has a rare form of leukemia, she wishes the lab results were different: "About half the time we're delivering not good news."

On the other hand, she noted, for anyone considering entering the field she has nothing but good news: "doctors are ordering more lab tests than ever before, and there's a crying need for lab technicians.

"Plus, it's exciting. Every day we're solving puzzles, solving mysteries," she said. "If you like critical thinking, this is the job for you."

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