Stories From Homeland, Part 2

Mrs. Mold, it turned out, had a bladder infection, with greater than 100,000 Aphus Glaphusiosa, according to the lab report. Dr. Bludgeon was visiting patients and charts at the Green Wing nurses station, and ordered Gentamycin via injections, dose to be calibrated by Evilgreen Pharmacy. I faxed off the order to the pharmacy, which called me and asked what the resident's last BUN and Creatinine labs were, which reflect kidney function.

Last such labs were done in June. Unacceptable. I pick up the phone and am in the midst of ordering a stat or ASAP lab draw when I remember that Mrs. Mold is currently out with her daughter, Isabel, dancing. I leave a message on her daughter's cell phone explaining the necessity of returning so the labs can be drawn.

A few hours later Isobel is standing at the nursing station counter. "I want her to have a urine dip!" We explain that this is not necessary, as the urine has already been cultured and proven to have this particular bug. "How do we know this was not contaminated?" "Because there is only one species of bacteria, not a mixture of normal flora." "Why can't I have her urine dipped? How do we even know this is her urine, not mixed up with someone else's?"

This is the great advantage of having several nurses present; my negotiation skills are very poor. At last Isobel accepts that yes, this infection exists, and we can move on. We call the lab back and they are now reluctant to come out for the draw, but eventually show up. After the results are in, the pharmacy can set the dose and finally the antibiotic will be started, but not within the usual four hour window of time required.

Intelligent minds may wonder, if the patient was out dancing, how sick is she anyway. In the world of nursing, required to follow doctor's orders unless really contraindicated, inquiring minds will just have to wonder.