Monday, December 12, 2005

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?


Nurse Practitioners Save Lives said...

MRSA always seems to rear it's ugly, expensive head!! We see a lot of it in our obese patients also..
P.S. how about a link?? I really like your blog.

newFNP said...
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Nurse Practitioners Save Lives said...
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Anonymous said...

NewFNP. I am a FNP student at OHSU going into my second year. I like your blog. You seem very sharp and I am even more excited to do what you do as I read this.

By the way, Jesus Christ in fact was, to be historically accurate, killed by the Jews. He was a Jewish man in a Jewish society sentenced by Jewish authorities, but truth be told in its fullness, we all of us killed Jesus, and he died willingly, so we could be forgiven. I bet if you would have asked that lady, you would have found she was not anti-Semetic, but in agreement with me an the rest of Christian Orthodoxy.

Kelly O'neill said...

Jesus was not killed by Jews. Jesus remained silent during his prosecution. Pilate left it to the crowd. "This man has done nothing wrong!"... "I wash my hands..." the crowd (made up of dominantly Jews and Gentiles) screamed out "Barabus"....
The issue people have with this is not of actual history. The problem is philosophical and moral. -Before his trial he was asked of Caiaphas "Art thou the Christ, son of God" Jesus said "I am..."
Philosophical: Of all the claims Jesus made.. this one.. the almighty factor is so easily disprovable.. He would not dare claim it if it were not so. There is no logic.. no sensibility in dying for nothing. Dying for a lie.
No one would do that.....unless it were truth - an absolute.
Moral: it is difficult to explain this in short terms, but i will try. There are 2 main theories to morality - either/or and both/and. Our culture is so heavily misguided to believe the "both/and" theory as a means of blocking black and white and creating a justifiable background to our choices. Our attempt to tolerance in society. In reality there is no such matter. The either/or always emerges. It is either the story as told or some fabricated account... there cannot be both/and....ok - i need to stop on this rant.. xo to all