When you’re doing an infectious investigation, and we’re all guilty of not doing this, you really do need to look everywhere.  The kinds of patients that we get in the unit continue to be febrile, continue to have white counts, we don’t know why.  You need to look at every IV site, you need to do a rectal, make sure they don’t have peri-rectal, turn them to make sure they don’t have an infected decubitus.   I can forgive anybody that the first time through you get a chest x-ray, they’ve got an obvious pneumonia, productive sputum, it’s not a big deal if you didn’t strip them and look at everything, but once you’ve had someone who’s been treated for 3 to 4 days with a presumptive diagnosis, they’re still sick, they’re still febrile, they’ve had a big drop in their white count (and remember, a big drop in the white count is consistent with sepsis not with getting better).  You need to say, I’d strip them, look all over their skin, I’d look at their old sites.  Look at the IV sites, do a rectal, make sure they don’t have peri-rectal, look at them, look at their back and make sure they don’t have a decubitus