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Pathology Specialist: Alyssa Ziman, MD

December 2, 2022

December 2022

Alyssa Ziman, MD
Alyssa Ziman, MD

Institution: UCLA Health

Specialty: Transfusion medicine

Years Practicing: 19

In the blink of an eye, it seems, I went from being an undergrad at the University of California, Los Angeles (UCLA), to a medical student at Sackler School of Medicine in Tel Aviv, to a resident/fellow at Cedars Sinai Medical, to miraculously finding my dream job at UCLA. I feel incredibly fortunate to be where I am, and as I write this, I realize how utterly challenging it is to write about myself and describe a “typical” day when my job varies so unpredictably and widely from day to day. At the highest level, my role is to ensure that our blood banks have sufficient blood product inventories and that our laboratories consistently provide high-quality patient testing to support complex patient care at our medical centers. My job would not be complete without my incredible colleagues and coworkers who tirelessly work with me and are unrivaled in their ability to deliver quality care.

Here is how I spent a recent Thursday.

6:30 a.m. In my mind, I spring out of bed, race down to my Peloton, and get in an intense 30 minutes of cardio before I wake up my children and make them a gourmet breakfast. In reality, I hit snooze twice and only manage to drag myself out of bed when my husband lovingly reminds me that I am going to be late for work. Fortunately, by the time I make it downstairs, my husband has made me large quantities of caffeine and my children have already heated up their own frozen waffles. I read the newspaper, discuss a couple of interesting articles and current events with my family, and compete with them to see who can solve Wordle the quickest. Then, we all sprint from the kitchen table, race to get ready, and do our collective best to depart by 7:45 a.m.

7:45 a.m. My commute is relatively short, so getting to work usually takes less than 30 minutes. I used to enjoy driving my kids to school, but now my daughter (senior) and oldest son (junior) have started driving themselves and their younger brother to school, so my mornings are a bit less hectic and, sadly, less animated. During my drive, I listen to NPR, sip my coffee, and get ready for my workday.

As the CLIA (Clinical Laboratory Improvement Amendments) director, I oversee two labs within the UCLA Health system. One of my responsibilities as CLIA director is visiting one of our off-site labs semi-annually. Today, I visit the UCLA Micro­biology Laboratory in Brentwood.

8:15 a.m. I arrive at the UCLA Clinical Microbiology Labora­tory, which offers comprehensive microbiology and immunoserology testing for UCLA Health patients. I meet with the section chief, laboratory administrative director, and quality monitor. We discuss current issues that are affecting laboratory operations, key metrics, quality improvement projects, staff, and supply chain concerns (which have become significant in the COVID-19 era), and we do a walkthrough of the lab.

10:00 a.m. I drive to the Ronald Reagan UCLA Medical Center and have a moment to answer emails and collaborate and sign-off on a few standard operating procedures that must be completed today.

11:00 a.m. A transfusion medicine fellow and two pathology residents are rotating through the blood bank this month. Our trainees are responsible for managing the daily operations of our hospital-based donor center (assessing donor eligibility, managing donor adverse reactions, and informing donors of positive transfusion transmitted infection disease results) and the blood bank (interpreting immunohematology test results, consulting on adverse transfusion reactions, prospectively auditing blood product orders, managing patients with immune-mediated platelet refractoriness, and ordering unique blood products for patients with complex red blood cell [RBC] antibody histories and human leukocyte antigen negative/crossmatch compatible platelets).

As part of trainee and staff education, we hold a weekly immunohematology and apheresis case conference. Today, our fellow reviews a journal article on transfusion practice in pediatric cardiac surgery. After her analysis, we compare UCLA’s practices with those described in the article. One of the residents presents a patient with sickle cell disease and a history of stroke and multiple RBC alloantibodies who requires regularly scheduled RBC exchanges. We discuss the challenges of obtaining RBC units, given that less than 1% of donor units are compatible with his complex RBC antibody profile, and transition into a didactic session on potential complications associated with RBC exchange in this patient population.

12:00 noon Because it’s Thursday, I meet with the transfusion medicine physicians for lunch. We use this opportunity to socialize and discuss various clinical, research, or trainee topics. While we eat, we catch up on our summer vacation plans and quickly review the status of ongoing research projects in our division. It breaks up the day nicely and provides wonderful comradery.

1:00 p.m. I attend the weekly management meeting with the blood bank leadership team to review workflows, procedural issues, and new test and blood product initiatives. This meeting typically results in lively, inspiring, and productive discussions on how to improve collaboration with our clinical partners and the quality of care that we provide. Today, the discussion focuses on massive transfusion protocols, whole blood for trauma patients, readiness for an upcoming AABB (Association for the Advancement of Blood and Biotherapies) inspection, and specimen labeling errors.

2:00 p.m. The medical center’s location on the edge of the UCLA campus allows for the unique opportunity to support undergraduate student-led initiatives in transfusion medicine. The Bruin Blood Initiative (BBI) is a new undergraduate organization whose mission is to promote awareness of blood-related issues at UCLA. This collaboration is great, as it benefits pre-med students in receiving mentorship for their research projects and, in turn, we can get our message about the vital need for blood donation out to UCLA students by their own peers. Two of my colleagues and I meet with the BBI research group to further develop a project aimed at better understanding the impact of temporary donor deferrals on future donations in the college student donor population.

3:00 p.m. I meet with our compliance officer and transfusion safety officer to review the health system consent policy and, based on nursing feedback, to brainstorm ideas for developing a treatment-specific transfusion consent.

3:30 p.m. I touch base with the supervisors and administrative director to address active patient care and lab-related issues.

4:00 p.m. As division chief for laboratory medicine, I attend the pathology executive leadership meeting. During this meeting, I am enlightened by presentations on the quality and equity, diversity, and inclusion initiatives occurring in our department.

5:00 p.m. I spend about 45 minutes wrapping up the day, following up on emails, planning for next week, and finishing a couple of projects.

6:30 p.m. When I arrive home, I find my husband finishing his workout in the garage, smiling from ear to ear since he tends to work fewer hours than I do, relishing his end-of-day workout. As I enter the house, I am eagerly greeted by our two dogs, but my wonderful teenage children are nowhere in sight as they are all consumed with listening to music while they work their way through brutal AP classes, in subjects I swear I used to know and understand but now struggle to comprehend.

7:00 p.m. After changing into some comfy clothes, my husband and I pour a glass of wine and start preparing dinner. Dinner is animated and fun and includes everyone recounting the highs and lows of their day, and some discussion around the happenings of the world. This is my favorite time of day and always makes me giggle.

7:30 p.m. We clean up after dinner, help the kids with homework, play with the dogs, and hear more about everybody’s day.

9:00 p.m. Our kids retreat to their rooms to finish homework and connect with friends. I still need about 15-30 minutes to wrap up emails and deliverables from the day and prep for tomorrow. I multi-task while my husband and I binge watch one of our favorite shows, Homeland.

 

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