I Diagnose Your Diseases: 7 Horrifying Realities
Every day I look at a series of disgusting samples of bodily waste and diseased flesh to figure out why a patient is sick. I'm a microbiology technologist (a specialized type of clinical laboratory scientist). Whereas in a hospital drama there's a team of genius doctors who solve the puzzle of a mysterious disease, in real life those puzzles are solved by people like me.
But, thanks to shows like House (where the doctors inexplicably run the tests themselves) and the fact that we never see patients, most people don't know that this job even exists (even though 70 percent of all decisions involving a patient's treatment are based on the work we do). It's a job that's incredibly important, and also really, really gross.
Random People Try To Bring Us Their Poop
So why would strangers randomly show up to my lab with a box full of their own shit? Several reasons.
First, there's a disorder called delusional parasitosis. It's what it sounds like; people think they have parasites when they don't. We get them in the lab all the time, and it doesn't mean they're crazy. For example, remember seeing headlines about listeria-riddled hummus earlier this year?
Your move, baba ghanoush.
Every hummus-loving soul near our hospital started freaking out as soon as they heard the news, coming to us certain they'd been infected. When people hear about a parasite going around, they just assume that's to blame for any ache and pain in their body.
We once had a retired dentist call the hospital because he claimed he was seeing worms come out of his eyes. The doctor didn't see anything, but somehow this patient got a hold of the lab (the hospital's security guards can be, uh, too helpful at times). He spoke to a tech who is a master parasitologist, who explained, "No you have to go to your doctor to collect specimens the proper way, and then we'll have an answer." The patient didn't like that idea, and he decided to just start collecting stool samples on his own, the system be damned. He mailed us his specimens in a box, about 18 inches wide and 18 inches long. It was full of feces, as well as his and his wife's hair and skin, his dog's poop, and cat poop.
"Please refer to the scratch-and-sniff labels to identify the poop you need for your tests."
Obviously, it was all useless to us. You can't just drop shit off at the lab in a hat box. You have to preserve this stuff or it breaks down. Other times, patients just aren't particularly well instructed on how to collect their poop samples. So we've literally gotten things like poop on a plate, or patients who just scooped their shit into food containers and shipped it on down to our office through the pneumatic tube system (yes, like at a bank drive-thru). I'd describe this in further detail but, y'know what? Here:
That is one small pile of shit.
Another co-worker got stool in a chocolate pudding container. I've gotten it in mayo jars. Lunch Mate Tupperware is a popular choice. We've gotten it in I Can't Believe It's Not Butter containers ("Yep, I'll believe it"). I just got a lime-flavored mayo poop jar last Friday. Turns out that used to be my co-worker's mayo flavor of choice.
Used to be.
I guess they'll have to try one of the other perplexing number of mayo flavors.
Oh, and if you're wondering about eye-worm guy: We called the doctor, who contacted the patient and had him come by and give specimens the normal way. They were negative, but he still complained about the eye-worms. That's when we realized he'd had a recent change in his heart medication. So they changed him back to the old drugs and boom, no more worm hallucinations. His heart medicine had been the culprit all along.
Now, obviously that's the grossest thing we have to deal with, so it's smooth sailing from here on out. Oh, wait ...
Sometimes You Cut Into Massively Engorged Testicles
Let me tell you about a scrotal abscess I once saw.
Our patient had been in the hospital a couple of days. He had something else going on, diabetes, I think. Anyway, he had this abscess and it just kept getting worse -- festering and swelling to the point where I'm honestly not sure how he walked into the hospital. So doctors removed the abscess and sent it to us to check it for bacteria. It came in this giant white bucket with a lid. And the mass was about the size of a human head. Just a giant sack of fluid.
It was big enough for Rocky to use during a training montage.
I had to dig around for an uncomfortably long time before I found the guy's testicle inside. The doctors weren't even sure if it was still there at all. Words cannot describe what it feels like to cut into a giant, pus-filled testicle, only to find a real testicle buried inside it.
By the way, this happened on "bring your child to work" day. Yeah, that's something they do once a year here, for some reason. Parents all over the hospital compete to bring their children to the office. So those lucky winners visit our section and ask what I'm working on, and I'm like, "Well, I have this giant scrotal abscess if any of the kids want to see it."
Like any kid is going to say no to that.
They did, but their parents wouldn't let them. I was disappointed.
We Could, Potentially, Get An STD From This Work
For those wondering if there is actual danger involved in constantly sticking our hands into huge buckets of disease, the answer is yes -- if we're not careful. For example, we run these tests called vag screens. They're just what they sound like: a swab from a woman's vagina, so we can screen for yeast, Trichomonas vaginalis, and BV (bacterial vaginosis).
One of the most common ones we screen for is Trichomonas.
The Flying Spaghetti Monster of STDs.
It's a single-celled organism that swims, and it's good enough at surviving to routinely live through the powerful pounding of genital-on-genital sexing. So we're in the process of doing a direct microscopic screen, which means we take the swab and swirl it around a bit in a test tube of saline. Well, the guy doing the test drops the tube on his lap. And it spills.
The liquid STD soaked through the dude's pants, and the patient had tested positive for Trichomonas. The tech immediately bleached his crotch to hell and back, while I joked that he was the only I guy I knew who'd been exposed to an STD from a girl he'd never touched. Fortunately, he didn't catch anything. Thanks, bleach!
Added bonus: pubes that look like Billy Idol.
Now, I'm not saying this job is just an endless parade of infested flesh and oozing bodily fluids. But I am saying that ...
There Are Shit Volcanoes
Poocanoes are one of the first things we warn new techs about. Clostridium, a bacteria you find a lot in poop, is a major gas producer. So we get stool in these collection cups where the bacteria keep right on making gas once those cups are sealed. And the pressure just keeps building ...
That's right. You leave poop sealed for that long, it can explode.
Now, they generally wait until you're opening them to do that, and it is literally like a volcano.
Poopeii, if you will.
Think of a science fair volcano: It comes up, bubbles over, and you can't stop it. So all of a sudden you have exploding shit everywhere. I've had a couple incidents -- like the one where my co-worker gave me a stool container he hadn't sealed properly, and it exploded all over me. I had to get new scrubs sent over (we have a running joke that your scrubs aren't truly broken in until they're covered in bleach spots).
I mentioned earlier that we have a pneumatic tube system to transport samples and other items. It isn't a gentle way to travel, especially for "contents under pressure." So every so often, poop explodes inside of a tube. We have to throw it under a biohazard safety hood and bleach the shit out of it. We have a product called Dispatch -- a high-percentage bleach spray -- and it's the only possible response to a poocano. That and screaming.
No, We Can't Talk To You
There's an experience each of you have probably had at some point: Your doctor sends you off to get tests (X-ray, blood tests, whatever) and you've got a long wait until you see your doctor again to find out if you're going to die. But somewhere in the process you do have a chance to talk to the person who did the tests. Well, why not just ask them? I mean, you don't need a full diagnosis, just a reassuring, "I don't see any Black Death here."
"It's definitely not Ebola, either. Quite frankly, we don't know what to call this."
Well, if they seemed very hesitant to give you that information, that's because it's against the law in most states.
We're not supposed to ever have direct contact with patients at all. That also stops us from getting too involved, and thus biasing our diagnoses based on what we want to see, rather than what's there. But it's impossible to avoid making some sort of connection with the people we work on. We have one very regular patient whose samples I see constantly, and I have to make an effort not to pay too much attention to her case history. As long as we still get specimens, I know she's still alive. Focusing on more than that is just begging for a really sad day. Other times, we've had patients and their families hunt us down in the lab and ask us questions about test results.
See "overly helpful security guards," above.
I think the hardest thing I've ever had to do was tell a guy that I couldn't explain what was happening to his sister. She was the same age as me, had children, and she'd suffered a sudden aneurysm and nobody knew why. They sent us samples to see if it was an infection. It was all a moot point, because she didn't live.
But before she died, when the family made their way back to us for answers, I couldn't say anything but, "You have to talk to your doctor, you have to have faith in your doctor, I can't tell you anything." Again, telling them anything would have been illegal. And even if I'd been able to say something, I'm not a doctor. A good doctor can take very technical test results and translate them into something useful for a layman. I'd have just been Spock-dumping numbers and Latin words all over them.
"You're going to want to have Wikipedia handy for this."
Every Day, You Find Out If Someone Is Going To Die
We had a patient whose CT scans revealed they had these dark masses on their brain. Not to bore you with excess medical jargon, but dark masses on the brain are a good sign roughly zero percent of the time. The doctor's immediate suspicion was that it might be a blastoma of some sort, but the biopsies were inconclusive. So these pieces of brain tissue got sent to my lab for analysis. The assumed diagnosis would've given the patient around six months to live. But when the tests came back, it turned out he just had tuberculosis!
"Good news! Remember how you said Tombstone was your favorite movie?"
Yes, tuberculosis can be a cause for celebration. It's treatable. Sure, the patient had to take a long course of antibiotics, but that's a damn sight better than taking a long course of being a corpse. This guy went from "dying in six months" to eating a fistful of pills. So that'd be the best-case scenario. The worst-case scenario? Malaria.
Fun fact: Malaria has killed more human beings than any other disease in history -- maybe more than any other cause. Malaria is both why we have the Centers For Disease Control, and why its HQ is in Atlanta (aka, America's mosquito-basket). There are five types of malaria and the, shall we say, Hitler of the species is Plasmodium falciparum. Catching it is only slightly less deadly than shooting yourself in the head. Without an immunity built up, patients rarely survive more than a couple of hours outside of the hospital.
We had a patient who caught a face-full of malaria while she was doing aid work in Africa, because that's how our universe rewards selfless kindness.
"For as little as one possible death, you can feed 300 of my demon spawn. Please donate."
Malaria is serious enough that the lab drops everything else when a possible case comes up, so we were able to diagnose and get her into treatment within the hour. And as fast as we were, she still lost her arms and legs. And because malaria can't make anything easy, while P. falciparum takes you down within a few hours of symptoms, other species can hang out in your liver for 20 years. And then, one day, you get a fever and suddenly malaria bursts into your life like, well, an exploding container of shit.
People Fake Illnesses (By Injecting Themselves With Filth)
We see quite a bit of Munchausen's, people trying to fake an illness for whatever reason. Now, this is easy with a doctor -- they can just complain of some vague pain or fatigue, something that isn't visible to the naked eye. But if they want to keep faking it at the blood-test stage, they have to get serious.
"That is not your vein. That is clearly a bat taped to your forearm."
"So ... rabies?"
Now, whenever a patient runs a fever, doctors routinely collect blood cultures, because one of the first signs of sepsis is a fever. So we collect a sample and put it in a big machine. And when these cultures test positive we pull them, read the slide, and try to identify the bacteria in it. Sometimes the sample tests positive for what's clearly the problem, other times it tests positive for bacteria that's clearly just an environmental contaminant.
But we had one patient test positive for five different types of bacteria in her blood. One type is about the norm of a sick person. Two is extremely unusual. More than two, and there's something seriously wacky going on. So because five seemed impossible, they started investigating her hospital room ... and found syringes by the toilet. She'd been injecting herself with toilet water to make herself sick.
"If it's yellow, let it mellow. If it's brown, shoot it like Bubbles in The Wire.
Eventually, they sent us the toilet plunger to culture, to see if the bacteria in her blood matched ... and it did! She was faking it all along. But holy shit, you've got to appreciate that kind of commitment.
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