Sticking a Tube in Someone's Bladder, How Fun [Roderich and Braelyn]

There were three kinds of cases Roderich had to deal with on a daily basis--hospital-acquired infections, particularly rare or virulent infections and cases where the general practitioners simply didn't know what to do. This one was currently in the third category.

The patient, an otherwise healthy woman in her thirties, had been admitted due to a high fever, abdominal pain and bloody urine. She'd had a CT scan run on her to check for kidney stones but none had shown up. Urine and blood tests had revealed high numbers of white blood cells, indicative of infection. A test for some strains of E. coli had come out positive and the woman had been placed on antibiotics, but her symptoms had only continued progressing. Something else was responsible for her illness, and the potential complexities involved in finding out had caused her file to end up on Roderich's desk.

It would be best, Roderich thought, to get a clearer look at her urethra and bladder than the scan had provided. There could be tumors or cysts involved, after all, and he had a sneaking suspicion that the pathogen would turn out to be something really unusual, especially considering that up to eighty percent of cases were directly caused by E. coli. Thus, he'd decided to do a cystoscopy.

It was never all that difficult to find an anesthetist or two to join him, but nurses were a different story. The administration really did need to hire some more (he'd put that on his next email of complaint, he thought, along with his request that they install more hand sanitizer dispensers in the intensive care ward) and some of them, knowing the manner of cases he got, actively tried to avoid him. So it was that, the morning of the procedure, he counted himself lucky when he caught Brae by the nurses' station.

He hadn't really worked with her yet--their paths would cross by chance from time to time, but they always seemed to be in different rooms or on opposite ends of the building. He had no doubt, though, knowing her, that she would prove capable.

"Ms. Leveque," he greeted. "Would you mind helping me with something?"

Today was out to be a rather uneventful day for Braelyn. Leaning against the desk at the nursing station, one foot behind the other in a loose third position, she flipped idly trough her patient lists. From what she could tell, she wasn’t required to a patient’s bedside for at least another hour. Meaning, she had nothing to do and was currently bored, which was a shame really. The weather outside was perfect for the beach…

Braelyn shook away such thoughts; she still had responsibilities and a job to do. “I’m sure I can find something of use to do in the mean time,” she mused optimistically to herself. Funny that she said that for not a moment later, the sound of approaching footsteps made her turn around in curiosity, only to be greeted by a familiar face. As he voiced his inquiry, she could only smile and blink at the coincidence, that Roderich would seek her assistance when she could spare some.

Setting her clipboard down behind the desk, she placed her hands on her hips and responded, “I do not mind at all, Doctor Edelstein. I am free at the moment so it would be a pleasure to be of assistance. What do you need help with?”

He resisted the urge to smile as she faced him, maintaining his businesslike demeanor. There was another nurse there, after all, and he was bound and determined not to show Brae any special treatment--anything that might insinuate stronger feelings. He'd been fairly successful in that venture thus far, aside from the slipping that had occurred around Francis with what he now mentally referred to as 'the chocolate incident,' and he was going to work to keep that success going.

"I need to do a cystoscopy on one of my patients. Could you run down to the supply room and get the computer cabinet with the scope? I'll be in room 206. If you could aid me with the procedure as well, that would be appreciated."

Tucking a stray piece of hair behind her ear, she listened to him intently, her expression growing more serious when she heard what he was asking of her. Like her dancing, she took her position as a nurse very seriously because to her, responsibilities were to be done with the utmost diligence and importance; call it an attitude ingrained into her from her tutorage.

“Of course I will help you,” she said nodding, “and I will meet you in room 206 with the scope.” Finishing off her words with a small smile, she turned on her heel to head down to the supply room; she didn’t want to make either Roderich or the patient waiting.

"Thanks."

He headed into the aforementioned room, finding the two anesthetists there that he'd previously hunted down. They had been waiting there for a minute or two, making small adjustments to their equipment and having friendly conversation with the patient. The woman looked somewhat nervous--her hands were gripping the bedsheet rather tightly--so Roderich offered her a reassuring smile.

At least, he hoped it was reassuring. Unlike some of his colleagues, he'd never quite mastered the ability to muster up sympathy and cheerfulness at a moment's notice. The communication part he had down for situations like these--he made a point of explaining what he was about to do and why--but feelings tended to come out looking forced. His mind was a bit too analytical for his own good, he supposed.

"So I trust the nurses have explained what the anesthesia will be like?"

The woman replied that they had.

"All right. I really think twilight will be just fine. I don't like putting my patients all the way out unless I have to. This should only be a twenty-minute procedure, and with the sedation it will be over before you know it. All you have to do is lay back, put your legs up, pretend you're at the gynecologist's...well, I suppose that isn't a soothing comparison."

The woman managed a snort of laughter. Roderich smiled again, more realistically this time. The woman asked whether he wanted her to use the bathroom again, just in case, even though she'd gone not long before the anesthetists had come in.

"Oh, you might as well."

She rose and walked over to the bathroom. As she came out, Roderich noted that the time she'd taken to wash her hands had been too short--he wanted to mention that to her, but it didn't seem tactful at the moment. He watched her settle back onto the bed, bending her legs as one of the anesthetists rubbed her wrist with a gel anesthetic to numb it, then hooked her up to an IV to pump the stronger stuff into her veins.

Roderich rubbed sanitizer over his hands, put on a fresh pair of gloves, and stood watching her slip into sedation as he waited for Braelyn.

Braelyn tried to be as quick as she could with her assignment, she didn’t like tardiness, with haste in her step she quickly reached the supply room and it only took her a short time to retrieve the scope. In her head she was going to her studies from school; mentally she was re-reading her notes on cystoscopy It was a relatively simple procedure, it wouldn’t take that long and by the time it was finishes, she could continue with her schedule for the day.

Unfortunately, and she felt bad for making Roderich wait for this, as she was making her way back she had to stop to aid and elderly man to raise from his chair and well as speak with a very lost couple and direct them to their proper ward. By the time to reached Room 206, it had only been a few minutes linger than what she had wanted to take but she still felt the annoying mental prod of making someone wait because of her.

Entering the room, she pushed back her braid from her shoulder to hang down her back and painted a picture perfect smile on her face. “Sorry if I made you wait”.

His eyes flickered to the clock. She had been a bit long in fetching the scope, but not to the degree that he'd have to have a word with her. Besides, the anesthetists were taking their sweet time in checking connections and waiting for some gel they'd applied on second thought to the opening of the urethra, so it wasn't as though he'd have been able to start anyway.

"You're fine," he said. The thought crossed his mind that his response sounded suspiciously like a compliment, and he promptly turned that notion aside to keep himself from blushing. He took hold of the cabinet, wheeling it over to the bed, and set to disinfecting the scope for good measure.

Once the anesthetists were satisfied, he handed the scope over to Braelyn and switched on the viewing screen. Normally he didn't like to be hands-on with a procedure like this--he preferred to observe and comment. If it got difficult, he'd be ready to step in, but for now he'd let her guide the scope up the urethra.

"Whenever you're ready," he told her, holding the skin around the opening taut. "I'm looking for possible swelling or signs of inflammation missed in previous imaging, so please go slowly."

Her facial features remained indifferent and focused at Roderich’s words and she persisted to remain in this composure when he indicated that she would be the one to do the procedure. She wasn’t surprised but she did feel the slight weight of pressure upon her shoulders, which didn’t faze her. She worked well under pressure, she’d had a constant heavy weight of it upon her shoulders almost all her life and with the simplicity of the procedure, it gave her further comfort in her abilities.

Donning a pair of new gloves, she moved into position with the scope in hand, glanced at Roderich to establish that she was beginning, and with only the professional interest that she was being watched, she gently inserted the tip of the cystoscope into the woman’s urethra. At Doctor’s Edelstein’s instructions, she slowly glided the scope further into the woman’s urinary tract and into the bladder. Her hands remained steady and her eye remained intent on the lens as the scope scanned the interior of the bladder walls.

It was about then that her blue eye caught site of an abnormality upon the bladder wall. Focusing the scope upon it, Braelyn said, “Doctor, I believe I have found, from the looks of it, a bladder stone…”

Roderich immediately leaned in to take a closer look. A stone that hadn't shown up on the scan? Indeed, it had the appearance of one--a dark, somewhat bulbous mass. Polyps were normally a similar color to the bladder wall, so...

"Pull back a little," he said. "...Ah, yes. That's one."

As the camera retreated slightly, giving him a better look at the size of the stone in relation to the bladder, he realized that it could indeed have been missed. It was relatively small, though probably large enough to cause pain. It could be the cause of some of the symptoms, such as the bleeding, though the woman's high white blood cell count still made him wonder. Perhaps that was indicative of an entirely separate--

His thoughts cut off abruptly as his eyes locked on the edge of the screen, peering at something half-lost to darkness.

"Wait." His hand fell on Brae's shoulder as though to stop her, even though she wasn't moving the scope at the moment. "Wait. I thought I just...go up and to the left some more."

He watched vigilantly as the upper wall came into view. Sure enough, he had seen something--something about as small as the stone, but lighter.

"There's a polyp," he declared, sounding almost satisfied in spite of what the growth might mean. "Well. We'd better take a biopsy of that and break up the stone, to cover all our bases. Look around a bit more, too, to make sure there aren't any others."

Braelyn moved away so the doctor could see the mass himself and moved the camera as he instructed. From her studies she knew that bladder stones could be very painful and cause severe problems if left untreated. Through the cystoscope, she could see that the stone wasn’t that large but it could still be causing the patient some discomfort or some other symptoms.

In her professional, focused state, it didn’t bother Braelyn that Roderich was so close to her; personal space was a non-existent issue when you’re a nurse. Even when his hand fell upon her shoulder, she barely looked up. She could tell by his composure that he was doing his duty, as she was, and when he spoke up with urgency in his voice, she took a deep, yet subtle, steady breath as she did what he instructed.

From the corner of her eye, she could see his intense gaze upon the screen and she knew he had spotted the abnormality he had been hoping to find. Sure enough, after a moment of looking, Roderich announced his find a moment before she came to the same conclusion from what she too saw on the screen.

Braelyn was then given her duties: break down the stone, search for more, and take a biopsy of the polyp. These procedures weren’t really difficult, and she nodded obediently in response with a neutral, “yes, doctor,” and set to work.

First off, she completed the biopsy with a steady hand, seeing that the polyp was slightly more important than the stone. She took a small tissue sample from the wall of the polyp for examination, all the while keeping an eye out for more stones. Once the biopsy was completed, she proceeded to break up the bladder stone, she extended the flexible fiber through the extra tube in the ureteroscope that carried a small laser that would break the stone into smaller pieces so it could be passed naturally. All in all, no other stones could be seen, Braelyn checked thoroughly, and with her duties completed, so was the cystoscopy.

_{~Let me know if any of this is wrong... or such lol I’m trying and I find this interesting xD}

She had steadier hands than he did, Roderich thought. He'd noticed that from the start and he couldn't help feeling a stab of envy. Though sheer focus was never an issue for him, twinges of nervousness always crept into the edges of his mind when someone was closely observing his actions, making his palms start to sweat and tremble. A leftover fear of criticism from the days when he'd been graded on this sort of thing, he figured. There were some neuroses from his years of schooling that he'd never managed to get over.

He received the piece of tissue from her and promptly bagged it. A glance at the monitor told him that Braelyn was doing just fine when it came to pulverizing the stone, so he shed his gloves, walked over to wash his hands, and pulled a pen from his pocket. He filled out the label of the bag in thin cursive lettering--he'd heard recently that his handwriting had reached a certain level of renown among the lab techs, as it was the only cursive they could consistently decipher and distinctive enough in style that they always knew who to send the results back to--taking care not to touch the opening and contaminate his hands again.

Even though he was pretty sure that his hands were clean when he passed the bag to Brae, he dabbed sanitizer on them afterwards regardless. Better safe than sorry.

"Take that down to the lab for me," he said with a glance at his watch. "I can take care of the scope. I need to head in the direction of the sterilization room anyway."

He had a case of gastroenteritis to see--that ciprofloxacin had better have kicked in by now, he mused moodily--and Brae was certainly free to go, but before he set off he felt obliged to linger for a few minutes. The anesthetists had disconnected the IV they'd used to put the patient out, and he wanted to be there when she drifted out of her semi-slumber. He stepped over to her bedside, compelling himself to soften his businesslike demeanor into something like gentleness.


(You're doing fine, don't worry~)

Removing the scope carefully from the patient and replacing it in its former position Braelyn disguised the swell of self-satisfied pride she felt for a god well done by carefully removing and disposing of her gloves. She assumed she had done well considering that Roderich had not found it necessary to speak to hr about her actions; from her knowledge of him she knew he would have if he saw the need.

The procedure had gone well, smooth, and she found the gratitude for her ability to respond well under pressure but that hadn’t stopped the slight itch of tension from forming in her back. Not wanting to provide any reason for anyone’s attention to be turned towards her, she quickly disinfected her hands and took the bag with the tissue sample inside from Roderich once he was one with it, listening quietly to his instructions.

Her expression had remained impassive, even, during the entire procedure and it had yet to change into anything more than soft seriousness. Behind her, Doctor Edelstein mulled around the patient while the anesthetists busied themselves with the IV, Braelyn ignored them both save a simple nod in their direction and a short, spoken indication that she would do what had been asked of her.

With that, with the sample bag in hand, Braelyn made for the door to head down to the lab. Certainly Roderich had no more need for her and she wasn’t one to prolong a duty that was required of her.
_{(sorry this is late... I just started university so I’ve been busy)}

He lingered until the woman's eyes drearily flickered open. She made some half-coherent inquiry as to whether it was over, and he assured her that it was.

"We found a small stone and a polyp in your bladder," he informed her. Knowing what question was coming, he added, "We can't conclude anything about the polyp yet. I sent a piece down for analysis, so we'll know whether it's malignant within a day or two. At any rate, it's very small, so it shouldn't be that difficult to remove if need be."

Was that what had caused her bleeding? the woman wondered. Roderich suspected as much.

"The stone could've resulted in some bleeding and inflammation," he said. "But the white blood cell counts you had on your last test were really the kind I tend to see for infections. I think the polyp is probably related to that immune response. Again, I can't say for sure."

She took a few moments to consider that, then rose to use the bathroom. Roderich took her by the arm, helping her walk over there without stumbling, and then said his goodbyes. This case was certainly getting complicated, he mused as he wheeled the scope out. Hopefully, though, the lab results would clear things up.


*


The analysis of the biopsy, when it came, included a rather interesting picture.

It hadn't taken them long to find the foreign bodies--rounded shapes that were clustered with each other in the tissue. The techs hadn't known what they were, so they'd sent a photo back to Roderich, noting that they figured the shapes were some kind of parasite.

He only needed a single glance to determine what he was looking at. Eggs.

Schistosoma haematobium eggs, to be exact.

That would explain the woman's immune response--quite well, really, as her particularly high numbers of eosinophils tended to indicate a parasitic infection. The diagnosis would certainly come as a relief to her, too, as it was the only real problem--the lab had found no indications of bladder cancer, thankfully--and almost absurdly easy to treat. One dose of praziquantel would do the trick.

The only question was, where had she picked up the parasite? It certainly wasn't found in America.

He pulled out her file, tucked the lab results inside, and skimmed her history. There was nothing out of the ordinary there, really...except when he looked back to about a few months before, where someone had noted that she'd received treatment to a cut on her forearm. It had happened while she'd been on a business trip related to her military contracting job, in--oh, of course--the middle east.

Roderich could play it out easily in his mind--she'd touched some contaminated water, the schistosoma had penetrated the skin, entered a vein, circulated through her body down to the liver, fed and mated there, and migrated to the bladder to lay eggs. She'd only started feeling the symptoms after her return to the states--the incubation period had been long enough to keep anyone from making the connection.

He shut the folder, quite satisfied. He'd have to go inform her and put some praziquantel on order. And inform Braelyn, of course--she'd probably like to hear. It was around noon, so maybe she was in the cafeteria? Perhaps he could track her down...


(Lol, me too. Sorry for the ridiculously long post; I kinda had fun with this.)

The cafeteria was busy and the chatter of numerous voices dulled into a constant murmuring hum that Braelyn was completely ignoring. She sat at a lone table near the window, the overcast of the day prohibiting any sunlight from breaching through its dark clouds. She sat lounged slightly against the back of her chair, the remains of her Greek salad locked away in its Tupperware container, and at her ear was her blackberry.

With a rather dull and neutral expression, she listened obediently to the drone of French in her ear, answering accordingly in short sentences. Removing her glasses and pinching the bridge of her nose in exasperation, she patiently waited for the woman in her ear for finish her rant. Thank God, the end was near.

Nodding slightly, Braelyn sighed and responded as she always did with this kind of call. “Je vais y réfléchir, comme j'ai dit avant, et oui je vais vous appeler la semaine prochaine. Passez une bonne journée, grand-mère. Bonne nuit”.

Pressing the “End” button always sent a shiver of relief through her body but Braelyn also sighed, it would seem that her god day had just become as gray as the sky outside. Placing her phone next to her glasses, which she replaced on her head, Braelyn proceeded to ritually undo her braid to redo it, as if the call had physically rattled her perfect hair as it had with her mood.

Pulling the last part of her braid apart, she let her hair fall loose around her shoulder and dropped her hands, leaning her elbows on the table and resting her chin on her chin. Idly, she watched the scene of the cafeteria unfold before her: patients with their nurses, an elderly couple sheltered in the corner with tight, grim expressions, a couple small children playing rock-paper-scissors while their parents conversed in hushed tones

Absorbed, as she was with her reality theatre that she didn’t see his approach. When she did, she straightened respectively and a small smile faintly touched her lips. “Bonjour, monsieur, is everything okay?”

As Roderich walked up, he found himself momentarily distracted by her hair. It wasn't as though she ordinarily had it completely up, but the fact that it was hanging loose and undone served to accentuate how long and lovely it was. That, and the way the light from the window was shining on her...

He shoved those thoughts aside, coming to stand next to the table with his hands folded.

"I just thought I'd let you know the outlook for Mrs. Cardella is good," he said. "She has schistosomiasis, of all things. Must have been infected overseas. I'm going to order her some praziquantel and it should clear up swiftly."

He allowed himself a smile, which rose effortlessly to his lips. "Between that and stone you broke up, I doubt she'll have any more problems. There were no other abnormalities in the biopsy, and no complications from the procedure, of course...that really turned out well. You have my thanks."

With her thoughts still preoccupied with the phone conversation she just had present upon her mind, she failed to register his interest in her appearance at his approach. His news, however, did widen her smile into one that showed her delight to hear that a patient was going to be all right.

“Well I am truly glad to hear this, doctor, and there is no need for your gratitude. It was my pleasure and I am pleased to have been of help to you”.

With that said, Braelyn continued what she had started and re-braided her long, blond hair back into its usual braid. Shoving the two clips into place to contain her bangs from her face, she gathered up her things and stood, pushing back her chair to stand near Roderich.

“You caught me at a good time, Dr. Edelstein. I was just about to leave. Is there anything else you would like to say? If not, I need to drop these off at my locker. Your welcome to join me but... I wouldn’t want to keep you from any affairs you may need to attend to.” Shrugging a bit, she finished, a bit nervously, “it is your choice” before motioning towards the cafeteria exit.

His gaze was caught again by her hair as she braided it. He didn't notice that he was staring at first, but then as the silence stretched between them he caught himself and cleared his throat as he gathered his senses. It came out, he thought, sounding a bit too much like a cough. Hopefully she wouldn't think he was ill--he was teased fairly mercilessly by his fellow staff members on the rare occasion that he did get sick.

No, he thought. She wouldn't. He was the one that tended to suspect illness at the appearance of the slightest symptoms. He was being too anxious. She was a well-adjusted, beautiful--

"That was all," he said, putting a halt to his jumbled thoughts, though not quite before a tinge of redness colored his cheeks. "I figured you would like to know."

With that, he turned on his heel and forced his mind to focus back on work. There was no need for any of his romantic inclinations here--he and Braelyn were professionals in a professional setting, and he wanted nothing to compromise that appearance of professionalism. He had an image to uphold.

Hm. She watched him walk off and felt no hurt or anything, just shrugged with acceptance; duties of the hospital were more important after all. She returned her things to her locker, before returning to her station and carried out the various jobs that as required off her until the end of her shift. She didn’t really think of Roderich, she was too busy ad by the time she returned to her locker at the end of the day she felt exhausted.

Quickly changing into jeans and blouse, she usually didn’t wear jeans but today was an exception, she gathered her things and a bag and headed towards the exit. Her plans for the evening involved at least two hours of dance; she may feel exhausted but dancing relaxed her and after she’d have a bath before bed.

The thought of a bath brought a smile to her face; ‘perhaps I’ll use the jets tonight in my Jacuzzi tub’. It had been a good day.

_{'Sorry for the late/crappy post... I did not know where to take this XD'}