Barney was one of the alcoholic street people who regularly frequented our ED for a wide variety of minor complaints. More often than not, his visits were little more than attempts to find shelter from cold, hot, or rainy weather, or to cadge a free meal. He was pleasantly harmless, having long since sacrificed a significant portion of his intellect at the altar of the Great God Thunderbird.
Barney seldom saw the action of soap and water. He usually waited until his legion of lice demanded attention. Barney knew it was bath time when even he couldn’t ignore the itch.
On this particular day, Barney presented with complaints of abdominal and right flank pain. Our new intern decided it was a UTI, or maybe even a stone, and ordered a clean catch urine specimen.
Clean catch kit in hand, I made my way to Barney’s bedside, suspiciously eying his clothes for animate specks. Standing a good six inches beyond even the most Herculean louse leap, I explained to Barney the procedure for obtaining a clean catch urine.
“OK, Barn, pretend my thumb is my unit,” I said, holding a hitch-hiker’s fist out in front of my fly. “You wipe yourself three times – one, two, three – then you pee into the toilet. Stop after a couple of seconds, and tehn you pee a sample into the cup. Got that?”
Barney nodded vigorously, grinning with a mouth that hadn’t been touched by a toothbrush in decades. His teeth had more gaps than a Watergate tape.
“Okay,” I said, “tell me exactly what you’re gonna do.”
Barney held out his thumb, mimicking my gesture. “I wipe myself three times – one, two, three – pee a little into the toilet, stop, and pee into the cup. Right?”
I nodded, not quite able to bring myself to clap him on the shoulder. “That’s it, partner. The john is right down the hall. Go get ‘em, kid.”
As Barney waddled away, I smugly congratulated myself on a job well done. As far as I knew, there were few nurses who had managed to penetrate Barney’s dense Thunderbird fog.
He returned several moments later, sample in hand, and a vague, helpful smile turning up the corners of his mouth. As he approached, I eyed the container, anticipating the usual sheen of slopped urine. Instead, I was immediately struck by the color of the specimen: greenish brown.
I thought, ah, this sucker has hepatitis.
Reaching out with a gloved hand, I took the cup and twisted off the cap.
A tendril of steam curled languidly from the sample, headed skyward.
I noted the cramped and folded substance within, then met my patient’s thoughtful gaze.
“Barney! This is a turd!”
Another helpful, gap-toothed smile. “Sorry. I just didn’t hafta pee.”
Contributed by Alvin L. Polk, RN