Water Difference That Makes

(I am a medical lab scientist. I receive a urine sample from the ER to test only for drugs, marked as belonging to a fifteen-year-old boy. The sample is quite clear — if someone is really hydrated that can happen — and it’s cold. We usually receive urine still warm, but sometimes it sits while they decide if they want to test it for anything. It’s negative for all the street drugs we test for. I release the results and then, a bit later, I get a call from a nurse.)

Nurse: “Hi. I was just wondering about the drug screen for [Patient].”

Me: “Sure. What do you need?”

Nurse: “Well, it was cold when he gave it to me, and I just don’t quite believe it’s negative. Is there anything you could do to find out if it was water?”

(I think for a moment and come up with a few fast things that I could do to find out whether or not it is water.)

Me: “Yeah, let me grab it and try something.”

(I do a really quick test and come up with something you would not expect for pee.)

Me: “Either this kid is in very severe kidney failure, or this is water.”

Nurse: “Thank you. I just graduated and passed my boards, so I’m still learning knowledge-versus-wisdom. Now I know when I feel like the urine feels cold, I should do something about it.”

Me: “Did you want me to credit those charges?”

Nurse: “Yes. We will be recollecting. And there will be a male care tech going in that bathroom with him.”

Me: *laughing* “I would imagine.”

(Once I get off the phone, I do some more chemical testing and learn that this sample has none of the chemical properties of urine. This kid didn’t even think to try the one where you dilute your actual pee with water — which we can also catch — or even to just put WARM water in the cup. It was straight, cold, tap-water. I walk across the lab to tell this one to the other lab scientists, one of whom is known for being extremely cynical about everything.)

Cynical Coworker: “That nurse is way too nice. I’d catheterize the kid. Teach him to never do that one again.”

(We then started a prizeless pool, guessing what the kid was on that he was trying to hide. In the end, the actual urine arrived, and it was positive for marijuana.)