It was a Saturday morning, and I had worked the past eight days. I was heading out to see an elderly woman with a suspected urinary tract infection. Her GP was hesitant to give antibiotics without a urine sample first, but during our home visits the patient had been unable to pass urine, her caregivers unsuccessful in catching a sample. I was hoping to capture that all-important first urination of the day.
I let myself in, calling out to announce my presence. I found Hazel sitting on the edge of her bed, smiling up at me. She reported that her carers had come and gone, provided a shower and breakfast, but failed in getting the sample. She apologized, as if her lack of bladder control was something she could control, and I reassured her she was not to blame.
She was still symp-tomatic, dizzy with a low-grade fever. My attempt to get a small vial of liquid stood in the way of her getting treatment. I asked Hazel if she was happy to try to provide a sample with me-something not always guaranteed, given my gender-but she readily agreed.
District nursing is always challenging, and one big difference from hospital nursing is the lack of equipment. Hazel didn't have a commode, just a chair lift over her toilet to give extra height. The sample container was tiny, difficult to accurately fill. Throw in poor vision and dexterity, plus severe leg weakness, and the idea of simply asking Hazel to fill the vial was not an option.
The key to district nursing is improvisation. After rummaging around I found, of all things, an unopened urinary bottle, an item usually used for bedbound men.
Improvisation take two. After experimenting with placing the bottle inside the toilet bowl, I found it wouldn't stand without support, meaning Hazel's valuable excretions could miss the opening altogether and run unhelpfully into the water below.
Improvisation take three. There was a gap between the toilet and chair lift seat where I could, just, squeeze my gloved fingers through enough to grip the bottle's handle and hold it steady. This meant, however, that I would have to squat in the bathroom door, literally an arm's reach from Hazel while she attempted to produce the goods.
I explained the options to Hazel and she was willing to give the setup a try. I admired her ability to tolerate an uncomfortable situation for the good of her own health. She was a team player.
I turned on the bathroom fan and tap, both to encourage Hazel's bladder and to create white noise so the lovely lady sitting above me didn't feel the need to fill any awkward silence with conversation.
The only remaining problem was, with Hazel sitting on the seat, I couldn't see if I had the bottle positioned accurately with her anatomy. I approximated as best I could, turned my head, and gave Hazel all the time she needed.
The hum of fan and tap filled the air with a meditative drone. The past eight days of work weighed on me, and despite the fact that I was gripping a bottle through a gap in a toilet while an 87-year-old woman did her best to pee, I felt myself relaxing. I rested my head on my shoulder, let my eyes close, and laughed at what a strange job nursing is.
Ten minutes passed and I suggested we let this chance slide. But Hazel insisted on trying a bit longer. I wanted to hug her, not because we were guaranteed success, but because she was willing to try her best.
After another 10 minutes, Hazel tentatively said she thought she might have passed a small amount. I let her know it was okay whatever the result. She gripped her frame and stood, moving to the sink. My fingers had gone numb, but nothing could force me to let go of that bottle. I gripped the nozzle with my other hand, relaxing my cramped fingers, and carefully lifted the bottle from the bowl.
I was nervous-even if Hazel had managed to produce some urine, I was unsure if I had caught it. And then, there, sloshing in the bottom, was 20 milliliters of yellow liquid.
The elation that followed would seem absurd to anyone but a nurse, but I felt like we had won a marathon. I heartily congratulated Hazel on her efforts, and she smiled, happy the attempt had been worth it.
Nursing is a job that sometimes finds you investing emotionally in things you never expected to care about. I have peeled away wound dressings and grinned at the red, raw wound underneath, happy to see it improving. I have high-fived patients when they finally managed to open their bowels after days of laxatives and suppositories.
And I have stood, tired and euphoric on a Saturday morning, holding up a bottle with a small sample of urine in it as if I were holding a trophy.