Harry’s Big Day: The History Of A Dastardly Practical Joke

Harry wandered in, mumbled his announcement, and wandered whence he came. I heard myself mutter, “We just can’t leave it,” “No we can’t,” Hilary chimed in.

Technicon SMA 12/60

Technicon SMA 12/60

This is the story of my most dastardly practical joke, and I seriously doubt that I will better it (which doesn’t mean I will not try). Let me set the scene. It was in olden times, i.e. the 1980s, before the personal computer and well before mobile telephones. The nearest thing most people came to a computer was their electricity bill. Still, the march of Science had arrived in our little Clinical Chemistry Department of our little suburban hospital. We still had a few test tubes and Bunsen Burners. I recall performing an enzyme assay for Acid Phosphatase (a test for prostate cancer) using a rack of test tubes suspended in a water bath and I suppose the Radioimmune Assays for hormones – then the big thing – did use dozens of little plastic tubes, but on the whole the test tube thing and naked flames were on the way out; most of the work was done by machines.

Greg Saunders of CSI and his bank of wiz bang, internet enabled, Deep Minded gizmos were 20 years in the future. Instead a company called Technicon had cornered the hospital chemistry market with the notion of a bubble. In the most simplistic terms, a drop of blood serum was sipped from a little plastic cup held on a carousel and diluted with water, salts and detergent to become a sample. This sample was feed through clear plastic tubing where it was mixed with chemical solutions, and the resulting chemical reaction produced a color change, which was measured using a photocell. The bubble prevented one sample drop washing into the next.

The machines were magnificent, and their memory is sadly lacking on the Internet. The chemical solutions could be vibrant colors, such as a deep magenta for measurement of total carbon dioxide. The form of the machines was a network of transparent tubing, imbedded with handsome springy glass coils, oil heating baths, transparent acrylic blocks and finally blocky colorimeters. The biggest machine in the lab was a magnificent SMA2 whose great rack of tubing was back-lit, highlighting the flickering voyage of the bubbles, and the magenta and peach solutions. All in all, they were something I feel Willie Wonker would have been proud of.

The bulk of the analyzes and running these machines was done by the serfs like Hilary and me, who gloried in the name of Medical Laboratory Scientific Officer. Harry, however, was of the nobility, a doctor destined to become a consultant. On that glorious morning when Harry made his big announcement, Hilary and I were doing the second most popular set of tests, those used to assist in diagnosing Liver Function. We used blood serum but there were some test tube tests for liver function performed on urine. Harry’s announcement? He had asked for an opportunity to do a pee test for liver function.

He had asked because he was taking the big exam, the one which made him a Consultant. He had already passed the written portion of the final exam but unlike the exams you or I would take, after the written bit there was a practical bit. And the practical bit had teeth; if you failed it then you had to do the whole exam all over again. Just the kind of thing to catch Harry – a low riding, laid back, Hush Puppy driving individual – out.

Harry wanted to practice.Ho, ho, ho! Hillary and I would give it to him. This was an act of some temerity on our part. Doctors, as you undoubtedly know, are far more intelligent than non-doctors. Only they have opinions which have merit, on the human body and pretty well anything else. To publicly mock one in his natural habitat was not necessarily a hanging offence. This was not the Japan of Edo, but it was not the done thing; words would be said.

Technicon sample carousel

Technicon sample carousel

Once, when I was the on-call chemist working in the evening, the duty admitting surgeon sent down a sample for the standard tests for admitting a patient, a Urea and Electrolytes, done on the glorious SMA2. The patient had an ‘acute abdo’ as we say, a painful stomach. I suggested that I also did the test for the enzyme Amylase which screens for pancreatitis. This ailment causes nasty stomach pains but is much loved by surgeons because in patients with pancreatitis surgery is contraindicated, as they say. The immediate treatment is to tuck them up in a cozy bed with lots of morphine and fluids, and wait for the consultant round in the morning. However there are many other abdominal pains,  e.g. appendicitis, which do require surgery. After an hour or so, a groggy patient was in the receiving room of an operating suit and a  newly minted consulting surgeon, not the admitting surgeon, was reviewing his notes. The aforesaid was a Mr.: a fully certified surgeon will insist on the Mr. instead of Dr. to which he is perfectly entitled, to distinguish them from those mere purveyors of potions. The attachment to being a Mr. (or a Miss – I never met a Mrs. but undoubtedly they exist) is something which harks back to when the principle skill required of a surgeon was to remove a leg in less than 25 seconds and follow that up with a good shave. Mr. – I forget his name – called and wondered if I might do the Amylase after all. Alas I didn’t have enough blood so he sent me down some more. The test included a 20 minute incubation/cooking time, so for around half-an-hour the operating theater, surgeon, anesthetist and staff waited. I suspect that during this time a rather cross phone call went from operating room to Casualty; a fiery dressing down down the clearly defined totem pole. This is my theory anyway. From then on every patient Dr. P admitted that night also had this Amylase test requested. By the 7th patient, I was well past just complaining to my team of doctors. I was fuming and marched into the little office, to be confronted by one of the most beautiful women I have ever met –  Dr. P  and her  exquisite almond eyes. She apologized and I was allowed to say it was my pleasure, shucks.

Hilary and I laid our plans well. First, we concocted our urine sample, A.K.A. The Bait, with tap water, a splurge of blood serum for protein, a spatula of glucose, some aspirin (which Hilary swore would work “just like urobilin”) and a drop of bilirubin, the yellow pigment of jaundice, from an old brown glass stoppered bottle hidden away in the dark recesses of the chemicals store. I invented a patient who I called Eileen Whitling, The word “whitling” sounds like a family name and my thesaurus told me was from the Anglo Saxon for a lie. She had a test request card created for her which put her on Intensive Care unit (ICU) and gave her a diagnosis of ‘Acute Abdo’, i.e. her tummy hurt, a lot. much like Dr. P’s patient. The plausible back-story was that poor old Eileen had arrived in Casualty feeling very poorly and was clearly unwell; what of, no one knew, perhaps pancreatitis, so she had been sent to ICU to be carefully monitored, and meanwhile a bunch of tests had been ordered looking for clues. Now, it so happens that the first symptom of acute liver failure is bilirubin appearing in a patient’s urine so there were good clinical grounds to do the test. The fact that over the previous two years Harry had never had such a request didn’t seem to bother him. Nor did he notice that The Bait was the only test requested for Eileen. To make The Bait a little more convincing I put it in a high risk bag reserved for suspected Hepatitis patients. On the off chance that there really was an Eileen Whitling and she was on the ICU I called sister in charge of the ICU to tell her about the plot. Very, very unlikely but stranger things have happened.

Now the hardest part: waiting. I recall having The Bait in place dangling from a brass hook on the pigeonholes of the separating bench, the initial point where samples were received. A crack crew such as Hilary and I zapped through the day’s analyses, converting graphs drawn by the machines to numbers and writing up the report cards, well before 4 pm which was last call for the report cards to be glanced over by a medico or a biochemist and sent out to the wards, the GPs and the satellite hospitals. Harry had seen the treasure, carefully folded back the results sticker to read the fallacious patient detail and quietly burbled, replaced the prize on its hook and wandered off, again – he did do a lot of wandering off. The minutes ticked by. I found myself on several occasions wandering towards the separating bench to find a mildly expectant Harry hovering around awasting time. I found my face spreading into the broadest grin and had to turn away smartly and find cover. Folk started to accumulate around the general area of the separating bench. They made half-hearted, general conversation. They frequently glanced at (a) the clock and (b) The Bait .

At long last Harry came through, collected The Bait, inquired as to whether there were any more, was told no, and proceeded with as much aplomb as he could muster into the bowels of the lab to perform these most vital of tests. Hilary and I were invited to the hospital bar for a quick drink. She declined as she had to go home to make tea. How everyone knew I do not know to this day. Our preparations weren’t terribly subtle and someone with some knowledge could have figured out what was afoot. Hilary claimed she hadn’t told anyone. But there you are – the only person in the lab who didn’t know was Harry. Moreover, the noncommissioned management must have known fairly early in the afternoon and could have stopped the prank in an instant. Yet they just let it roll along. Seems that various people had a rather low opinion of our Harry.

So we sat in the bar supping tepid beer waiting for the shoe to drop. Christine – one of the seven Chrises in the lab at the time – arrived late to report that Dr. Harry was carefully performing the tests, carefully measuring the test ingredients, which was totally unnecessary in these qualitative tests. He had picked off the two easiest, those for protein and sugar, first. They proved to be splendidly positive. Then he did the bilirubin test which was also satisfactorily positive. Harry apparently started chortling. Poor Eileen may have succumbed to some dreadful autoimmune disease which was damaging not only her liver, but her kidneys and pancreas. This would need careful investigation. Christine described his enthusiasm as gruesome. Then Helen decided to up the ante and called him to make a totally specious request as anewly minted admitting clinician. This combined with rather lackluster performance of aspirin to imitate urobilin gave the game away. Harry’s wife who had patiently waited for him while he was doing the tests took the poor man away.

The next day a zephyr blew around. Helen caught the little ire that Harry felt but mostly he was disappointed to find that Eileen would not be needing him.

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