Mystery of the retained urine: Sweet Medicine – Bitter Coating

This happened to one intern in AIIMS, who we will just call Dr. X. He was a brilliant young man, topper in many national exams and dedicated student. He was posted in Casualty (Emergency department) during his internship. He had night duty on the very first day of his posting. At around 9.30 PM, a patient came who was unable to pass urine for the whole day. He was in great distress because of the pressure of the retained urine. 

The patient was seen by Senior Resident (S.R.) surgery and a tentative diagnosis of Prostate hypertrophy (BPH) causing urinary retention was made. After consultation with Urologist on call, it was decided to put a urinary catheter to drain the urine and the patient was then to consult Urologist next day in the urology OPD. Dr. X was entrusted with the task. 

            Dr. X quite excited as it was the first opportunity for him to do a difficult catheterization in a patient with urethral narrowing. After taking full aseptic precaution and good topical analgesia, he successfully inserted the catheter into the urinary bladder. The urine that was under great pressure started flowing out and started soiling the patient and the bed. Dr. X in his excitement has forgotten to keep a urine bag handy to connect to the catheter. 

He demanded the nurse to immediately to get the urine bag. It happened the bag was stored in a cupboard and there was a delay in getting it. During this period around one liter or so urine has flowed and spread all over the patient’s clothes, the bed, and the floor. After most of the collected urine has flowed out there was just a trickle now. 

Dr. X was fuming by the time the bag arrived. He connected the bag to the catheter, fixed the tubing to the patient’s thigh, removed his gloves, wrote his notes and advice in the patient’s paper and sent the patient home. He got busy in his work. 

            At 5.30 in the morning, the patient came back in distress to Casualty. He has not passed urine in the bag since the time he has left the Casualty. On inspection by Dr. X, the urine bag was found to absolutely empty. The patient’s urinary bladder was found to be full on physical examination. He consulted the surgery S.R. Even he wondered what was the cause. He asked him to disconnect the urine bag from the catheter and see. 

As soon as the bag was disconnected, urine spurted out of the catheter end and drenched Dr. X. On close inspection of the urine bag, it was found that Dr. X in his hurry to connect the bag had forgotten to remove the protecting cap on the connecting tubing. Because of this, the urine was not able to drain in the urine bag.

            He learned his lesson that night, that do not let anything disturb your attention from the task at hand. Pay attention to the small details to avoid discomfort to the patients and embarrassment for yourself. Many times our colleagues, co-workers, and our patients disturb us. In this situation, take some seconds to calm yourself. Detach yourself from the emotional turmoil. When you are disturbed by any reason, be very careful and pay extra attention to the task at hand. This extra attention will also act as a calming device like meditation.

(Based on allegedly true incident)

— ND
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 DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm. 

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