Tom Smith worried he was in for trouble on a Wednesday morning last November, when a supervisor pulled the assembly line worker aside and told him to report to the factory nurse's station.
There, with a plastic urine specimen cup in hand, 40 ounces of water sloshing around inside him and the nurse waiting expectantly, Smith says he spent three hours straining to do what most people barely think about. But when the time allotted for the random drug test was finished, the cup was still empty. And Smith was out of a job.
The story sounds like the makings of a bad joke. But Smith and workers like him say they are tired of being the punchline.
Their problem, a little-known phobia known as paruresis or shy bladder syndrome, isn't new. But the intensely personal malady is getting some unwelcome exposure, an unforeseen consequence of widespread workplace drug testing.
Employers conduct about 45 million drug tests each year, the vast majority by collecting a urine sample. Some workers object, but inability to fill a specimen cup is rarely the issue.
Then there are people like Smith, who says he was fired from his job at a Caterpillar Inc. generator plant in Griffin, Ga., last fall because his failure to provide a urine specimen was labeled a refusal to take the test.
"You tell me I have three hours to urinate and I'm going to lose my job, hey man, I'm frozen. I can't do anything," said Smith, who lives in Pike County, Ga., about an hour south of Atlanta and worked at the plant for more than three years.
A Caterpillar spokeswoman, who confirmed Smith is a former employee, said she could not comment on the situation due to privacy concerns. But she defended the testing program.
"The safety of our employees is our primary concern," said the spokeswoman, Lori Porter. "Caterpillar follows the drug test collection guidelines that are outlined by the Department of Transportation and the DOT guidelines have been tried and tested in many ways and are proving to be the standard in the U.S."
Problems like Smith's, while unusual, are not limited to Caterpillar. In one of the more visible examples, in early 2002, the captain of a ship operated by the New York City government was suspended without pay after he failed to provide the urine needed for a drug test.
Employers often regard such situations as a refusal to take the test, workers and advocates say. Some employers have ordered workers to undergo examination by a doctor to determine if blockage of the urinary tract might be to blame.
But experts say paruresis is psychological, not physical, and that it is far more widespread than most people realize.
"The bladder's full, they're sweating bullets, but they can't open up" the muscle that allow urination to take place, said Dr. Michael Chancellor, a professor of urology at the University of Pittsburgh.
For some people, the answer is just to go into a bathroom stall. But more serious cases can require therapy and are not easily solved, Chancellor said.
That has led to a host of problems as drug testing has become widespread, said Steven Soifer, president of the International Paruresis Association.
"I get an e-mail a week or a call a week" from people unable to urinate for a drug test, said Soifer, an associate professor of social work at the University of Maryland in Baltimore who has contended with paruresis since childhood. "It's in every situation you can imagine — schools, prison probation, pre-employment testing and employment testing," he said.
When nurse Lee Attema moved from Massachusetts to Houston last year, a local hospital offered him a job, along with a signing bonus. But Bayshore Medical Center's requirement that he take a urine test before his late May start date quickly became the source of friction.
Attema says he has struggled since childhood to urinate in public and asked the Pasadena, Texas hospital's personnel department whether alternative tests were available. He says he offered to provide a blood sample and pay for the test.
But hospital officials grew increasingly annoyed at him for refusing to cooperate with their testing procedures, eventually suggesting he look for work elsewhere, Attema says.
"It turned out to be a big issue with them," said Attema, who has since found a job at another hospital that agreed to test him using a blood sample. "What it came down to is if you can't give a urine sample under supervised conditions, we just won't hire you."
A hospital executive, Tommy Doss, would not comment, citing privacy concerns.
Even in situations where employers are accommodating, workers with shy bladder say the phobia can make the job stressful.
In his job as a marine engineer on New York's Staten Island Ferry service, Michael Capparo has long been subject to spot drug tests. But he's so worried about not being able to provide a specimen that he carries a catheter in his work bag every day and leaves another in his locker just in case.
When he was called for his last test, about 3 years ago, Capparo says he inserted a catheter himself to ensure he could provide a sample.
"To be honest with you, every time I leave the door to go to work, I worry about being tested," said Capparo, who has informed both his employer and labor union of his problem.
Officials at Caterpillar's Georgia plant instituted random drug checks about a 1 1/2 years ago. When his turn came up, Smith says he knew he might have trouble. So he immediately drank 40 ounces of water provided by the company, to no avail.
Smith said the company suspended him the next day and let him go two weeks later for refusing to take the test. Smith said he offered to provide a hair sample for testing, but that the offer was rejected.
He and other workers say they don't object to drug testing, just to the reliance on urine.
Some workers with shy bladder are putting their hopes on the growing use of alternative screening methods that test specimens of hair, saliva or sweat. The alternative methods are already used by some employers, including casinos and police departments.
But they could get a boost in coming months when the federal government plans to propose such screening for its own workers. Federal drug testing standards are widely followed by private employers.
"I have nothing to hide," Smith said. "All I ask for is a reasonable accommodation based on my disability."