It was week 3 or 4 of being a student in the emergency department, not unfamiliar territory since I'd been working as a patient care assistant (PCA) for two years at royal Darwin Hospital. It is a little hard to explain public hospital culture in the territory. RDH is full of patients that sit in their bandages on the grass, many have lice and scabies, drop rubbish wherever it falls whilst picking through each others hair like monkeys out the front of the hospital-nice look. My favorite though was our very generous 4 hour absconding rule where you may or may not need the police to retrieve the patient, or if you were lucky they would make their own way back in their own sweet time - even sober sometimes.
This paticular day I am dealing with an older, but not old gentleman with peculiar habits. The chart says one particular mental health condition but I am seeing more obsessive compulsive disorder. During breakfast and morning cares it is so frustrating it starts to get testing with the 'I can only have this or this, it must be in this type of cup', and various assisted repostioning. I sigh and get on with it.
The doctors come and talk with the patient and request a 'hot' urine specimen. This is a fresh one which needs to be sent to pathology within half an hour for renal tests. We try the urinal bottle on the bed when he thinks he can go, he needs to stand up, fair enough we say we'll try sitting on the edge of the bed, it can support your weight..still no good. Two of us help the patient stand steady and it still doesn't work. He asks to go to the bathroom, fair enough..pity with his fussiness this involves much fussing around but we finally get there. He sits on the toilet and I have to hold the urine bottle in the front as he grips the bars on the wall. I am crouching next to him and my preceptor stands at the doorway, the frustration of dealing with him during the morning is beginning to make us lose our composure.
'Its coming its coming' he says..nothing happens for a moment..then he starts to loudly fart foul smelling wind. I look up at my preceptor she is starting to lose it, within seconds she has ducked out to safety. I just look at the floor and bite my lip, hard. 'Now it's coming' he says enthusiastically but no urine materialises. The farting getts louder and the smell intensifies, I start to hear shit being fired out, sloppy with machine gun force into the bowl. It's too much! I am currently still on my haunches next to this performance. 'I'll be back in a minute' I manage to mutter, mid choke, and sort of climb out of the small cubicle crab style. I shove the door shut, and one look at my preceptor is too much. I am sitting on the floor outside the bathroom unable to speak, laughing so much I can't make a noise, or get my breath, tears rolling down my cheeks. this has set my preceptor off and the other staff at the desk are not sure what to think. Both of us try to calmly tell the doctor why we couldn't get a hot urine specimen, but it comes out with staccato sobs of laughter and its infectious, he is laughing by the end of the story too.
I regain composure and help the poor man back to bed and make him comfortable. whilst fixing up another patient in the quite open ward we apologise for our carry-on. 'Oh don't worry about it, we've been putting up with him all morning' she says. Toileting patients is usually just part and parcel of the job and appropriate, but the morning had just got more and more frustrating that the laughter valve just had to release somewhere.
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