Take that, 911!

Yesterday, in the midst of uncontrolled hypertension and diabetes (see 'Rant'), the 7-year old patient in the next room was having dyspnea.

I swear, the kid looked fine when he walked into the clinic, but by the time I saw him in the room, his fever had shot up to 104.0, his 02 had dropped to 90-93% and he was sweating like a west coast native during a New England summer. The only thing missing was frizzy hair. In addition to these alarming findings, his eyes both got red and puffy. Not the way newFNP looks around grass and cats, but peri-orbitally he just looked wrong.

In addition to the fever, he also had rhonchi & wheezing so newFNP treated him to grape flavored Motrin, strapped him onto the nebulizer and put a cold pack behind his neck. In the back of my mind, I was wondering if I should treat him for the likely pneumonia or send his ass to the ED. And this is where the struggle of community health comes in.

The kid perked up, but still didn't seem A-OK to me. I was content to send him to the ED with his mom and three siblings, but they had no car. I asked her to call someone but no one was available to help her out. At this point, newFNP wasn't convinced that the kid needed an ambulance, but newFNP was also distinctly uncomfortable with sending him home.

As such, 911 was called to save the day. Of course, the kid looked super by the time the four paramedics arrived. As I recounted his tale, sounding like an idiot as always ("Um, I can't remember his BP - sorry"), the strapping, capable and tough paramedics looked upon newFNP as a nuisance, a burden, an embarassment to medical/nursing professionals everywhere.

Well, fuck them because the kid's mom called and told me that her son stopped breathing in the hospital. Now, I don't know if he de-satted or if he really stopped breathing, but he remains in the hospital as of now. All through the night I was wondering if I had over-reacted, but I am so thankful that I made the decision to send him.

Take that, hot paramedics! You think you know everything with your pecs and your biceps and your six-foot-three! Blow me.

Rant

NewFNP is tired today. When newFNP is tired, newFNP is pissy and easily frustrated. It's a familiar rant - the one I am about to share - but a rant I continue to feel the need to express nontheless.

If you are nearly 300 pounds, with a BP of 191/106 and a glucose of 425, don't fucking tell me that you are on motherfucking Jenny Craig or Weight Watchers or that you are Sweating to the Oldies. Just tell me that you had a Double Western Bacon Cheeseburger for breakfast and that you might just have a repeat for lunch, extra mayo and a large fries. Do not blow sunshine up newFNP's ass, especially sleepy newFNP. Because newFNP will hate you.

Part of the problem with being newFNP is that, as newFNP, you like to get straight A's & maybe one B in some bullshit class. Well, when you are my uncontrolled diabetic and hypertensive patient, I get an F. And it's your fault. Like a group project gone woefully awry.

I'm willing to work with you and even carry the burden of our group endeavor. But don't piss on my head and tell me it's raining. Oh, My Lady of Uncontrolled Chronic Disease, why must you torture me? You are too young for nephropathy and LVH, and you understand me because we speak in English. Yet you do not heed my sage advice.

And newFNP stayed up too late last night to be empathic newFNP to all patients today. That is a burden of the role. One must be on one's game, even when one is a crabapple. Therefore, newFNP must now toddle off to bed so as to be stellar tomorrow.

Because that patient is coming back. Balls!

She don't lie, she don't lie, she don't lie.....

I'm sure that if there is one question on the minds of newFNP's readers, it is this:

What the hell is up with the coke nail?

You all know what I mean, right? It's the nasty-ass long pinkie nail that men sport. I have yet to see a lady rocking the coke nail. Aside from the male gender prevalence, these are the other demographic details I have amassed.

1) Men of all ages feel it is appropriate to advertise their love of the cocaine via a long manicured pinkie nail.
2) Men of varying cultural backgrounds find common ground in the coke nail. Does newFNP sense an opportunity for coalition building amongst cokeheads? The Million Pinkie Coke Nail March? Better wear protective eyewear!

NewFNP will take this opportunity to judge the pinkie nail. Judgement: foul. People need to head to the cokehead nail salon and chop off that disgusting talon. Ugh. Just seeing it grosses me out.

If anyone has insight into the coke nail phenomenon, please e-mail me at newfnp@gmail.com. I must gain understanding into this disturbing and widespread occurrence. Is there an alternative explanation? Is it just to clean one's ears?

Help me understand this frightening trend. I beg of you, help.

Follow-up visit

So, my yeast ear lady came back today. Sure enough, the culture showed budding yeasts. And for those who are keeping track, Diflucan does in fact work on extra-vaginal candida infections.

But here is the crazy part. My patient was not only rocking otic yeast.

As I skillfully manipulated the otoscope to visualize the canal, I perceived an eerie green glow. Did she have Kryptonite in her ear? Did she melt some Play-Doh in there?

In fact, no. She had a pseudomonas aeruginosa. And Cipro Otic costs approximately $80. How it sucks to be uninsured with an uncommon gram-negative otitis externa.

A Tale of Two Fat Ladies

The tale has almost nothing to do with fat, although both of the ladies around whom the tales revolve were in the mid-300 pound range. No, these tales are far more interesting to newFNP than fat.

Tale One:

How many times can one person consume antibiotics for an ulceration caused by moist flesh rubbing on its neighboring moist flesh? The answer: a shitload.

My patient has had an ulceration on her left breast for years. It comes and goes, it's purulent then not, it has been the target of antibiotic treatment time and time again, none of which at the hands of newFNP. As newFNP has stated time and time again, she is a tight-ass with antibiotics. Rather than empirically treat and given her ongoing love/hate affair with Amox and Keflex, newFNP cultured said ulceration and sent it off to the lab. Bye bye culture!

Imagine my surprise today when, in the midst of 17 patients seen in the morning session, I see a lab result screaming 'MRSA' sitting on my desk. No wonder the 2-year course of antibiotics didn't knock that sucker out.

Aside: newFNP had never actually recommended a bra as a component of treatment for a patient until I saw that those pendulous breasts, each bigger than my head, were resting unsupported on the patient's ample abdomen. Rx: BRA!!!

Tale Two:

Religion is important to many of my patients. NewFNP tends to keep any spirituality, or lack thereof, to herself but listens respectfully when patients share their faith. NewFNP has even been known to encourage spiritual counsel in times of distress.

My kind and compassionate patient today has relied upon her faith to support her during a difficult transition from married to separated. Her faith is so important to her that she brought a photocopied reading to drink in during her lengthy wait at the clinic. All in all, a smart move.

As I was examining her, she placed the readings on the exam table behind her. During her lung exam, I glanced down and noticed the word 'Jews' in the selection. During a seemingly thorough, entirely benign and incredibly distracted exam, I came to learn that her religion teaches its followers that the Jews are indeed responsible for killing Jesus Christ. I was frustrated and saddened, yet said nothing. What is there to say?

When TV is the cure

Cold & flu season has struck my clinic and, as newFNP has up to date information on the latest and greatest treatment guidelines, I would like to offer these words of advice to all of the patients streaming in and out of my clinic with body aches, fever and malaise: stay the fuck home. Watch some Daily Shows that you have TiVo'd. Check out reruns of CHiPs or Dos Mujeres, Un Camino. For the love of god, sleep - but do not expose me, my staff and my patients with pneumonia, diabetes and asthma to whatever you have brewing! And quit asking me for antibiotics. You're not getting any.

It's not that newFNP doesn't sympathize with how crappy one feels when one has the flu. It's just that a guiding principle of public health is to reduce one's exposure to potentially hazardous conditions. Your partner's herpes are acting up? I can't think of a better time to abstain. Granny has a touch of the TB? Don't share a non-ventilated close space with her.

But, you see, this goes both ways. If you know that your penis is leaking green discharge and you need to take a percocet in order to pee, don't hit up your special lady or fella for sweet lovin'. And if you are fluish, please have the courtesy of limiting your exposure to others. Sure, your family will suffer, but does that mean the entire community must as well?

Oh, and if your penis is leaky, that is a perfect time to hit up the clinic for antibiotics. We'd gladly give you a Rocephin injection! With Lidocaine and everything.