Friday, September 16, 2005

Week-end round up

As some of you may remember, I cultured a "rash" for herpes virus about a week ago. Yeah, it's positive. Time to learn the Spanish for "no, there is no other way that this is transmitted." OK, I actually know how to say that, but all of the other stuff I envision that appointment will entail is another story.

Physical exam finding of the week:
Inguinal hernia the size of my forearm. Reducible, thankfully. Lay the dude supine and bye-bye hernia. Stand up and watch out! How has he been walking around with this for TWO years?

Lab result of the week:
Triglycerides: 1755 (not a typo) reference range: <150. Hey buddy, how's that pancreas feeling?

A little word on obesity. As all health practitioners know, obesity exerts its deleterious health effects on virtually every body system. It also makes the physical exam much harder. I can barely palpate a liver on a good day and on a regular-sized patient. Give me an overweight abdomen and I will most definitely miss hepatomegaly. Are you a very overweight person in early respiraory distress? My auscultation will suffer because even my sweet-ass cardiology stethoscope won't be able to make it through the excess tissue to hear the lungs. And, without going into detail, I will just note that the pelvic exam on an obese woman is exceedingly difficult.

Pelvic exam tip: Shy cervix? If it's hiding from you, have the woman grab her knees and pull her legs up toward her chest. Poof! Magical cervix eliciting maneuver. I can't imagine what in the hell the patient is thinking with that one, but you've gotta get the cervix to get a good pap test!

NewFNP recognizes that there are many ways to care for oneself, which is why she got a facial today (and a bikini wax, but the wax was decidedly not relaxing - Boston FNP, you know what I'm talking about). The esthetician is a woman I went to for a few years before I left to attend the MSN program. She remembered so much about my life, about my family. It made me realize the importance of the personal connection in our work encounters. True, she was practically my gynecologist today and that is pretty damned personal. But I thought to myself that I wanted to reinforce my commitment to learning about the lives of my patients so that I can support them in more than their illness management. Which, in turn, reinforced that 15-minute appointments suck balls!

Yesterday, for the first time, I loved my job. And I started to feel like I was good at it.

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