You can't keep a good newFNP down

Since newFNP last exposed herself to a patient's aromatic purulent discharge in a not-altogether successful attempt, newFNP has incised and drained not one, but two further patient lesions.

Lesion one: lady business abscess. OK, not exactly lady business but suprapubic in locale and wholly a result of picking at one's ingrown hair. Hands. Off. Ingrowns. I restate my case initially argued in "Picky Evolution."

Lesion two: epidermoid cyst. NewFNP has been waiting for this since she first became acquainted with one during her independent study in derm.

NewFNP is floating in her derm dreamworld. Oh, how newFNP loves derm. Bring on the Retin-A, kiss that acne and those wrinkles good-bye. NewFNP would love to scrapy-scrape your big fat plantar's wart, just as she would love to inject your inflamed acne lesion with kenalog. NewFNP loves to draw pics of derm lesions. NewFNP simply loves derm. It's a pure, unadulterated love.

OK, back from dreamworld. So, an epidermoid cyst. Not pretty. It forces one to utilize culinary analogies when describing cyst contents: cheesy. Soft cheese. Soft white cheese. Rondele, anyone? The I&D is exactly the same, except that you want to get the sac which contains the contents out in order to prevent recurrence and numbing the patient is so much more difficult. The contents of the cyst are firmer and therefore require a larger bored syringe in order to introduce the lidocaine. Ouch, big fat needle.

What can ruin a perfect I&D is another provider's student attempting to horn in on the I&D action. And by horning in, newFNP means asking not once, not twice, but five times to either perform or observe the I&D. At each query, newFNP replied 'no,' each response becoming progressively more firm and annoyed, the last of which being, "You can stare at me all you want; the answer is no." Is the student six years old? No, no she isn't. Yet newFNP found herself speaking to her as though she were. There is a reason that newFNP does not have a student: because newFNP needs the experience herself. NewFNP still is gaining comfort in her role as pus-expressor.

Note to all students: when your preceptor says 'no,' there is a reason. Don't push it. Should newFNP even have to tell anyone that? NewFNP is certain that her readership is already savvy enough to realize the non-kosher maneuver by our student.

In the end, not even pushy student could spoil the supremely successful I&D. NewFNP was even able to disrupt and express the sac. You can imagine my happiness - bordering on beatitude.

Out of the mouths of babes

NewFNP has fallen in love with the well child visit. Yes, it's true that sometimes the 13-year old well child weighs more than newFNP. Thankfully, those visits are rare enough. But for the most part, well child visits afford newFNP a break from diabetes and BMIs of 45. NewFNP likes all kinds of well child visits now, but has always held a soft spot for teenagers. Especially ones that ask funny questions.

So, all in all, an average 14-year old male well exam. Thin, plays field hockey (quite unusual in my inner city area), respectful, has all parts intact and has no inguinal hernia. Testicular torsion education - done. Safer sex/abstinence education - done. Repeated denials of current or prior sexual activity - accepted by newFNP.

As always, when about to exit the room, newFNP asked, "Do you have any questions?"

"Yeah, I have a question," he replied. "Is it bad to masturbate?"

The way he asked was so sincere. I set the chart on the counter, faced him squarely and said, "No, it's not bad. Everybody does it. Just don't get caught."

He was visibly relieved. Whacky kids!

You never forget your first

It's true for any number of experiences. First kiss, first love, first bad grade (not that newFNP would know anything about that), first abscess I & D. Now, let me go on the record as having stated that newFNP likes gross stuff. But what newFNP does not like are gross smells. Seriously. NewFNP has never eaten ketchup because she is repulsed by its aroma.

Here is the sequence of events:

12:30 patient: mucopurulent cervicitis
12:45: lunch
1:15 patient: abscess

The smell. Holy shit, the smell. First of all, it was an ass abscess. Top of the rump, right gluteal fold. Second of all, there were 5 of us in the small MF-ing exam room. Me, the patient, her sister, the super-MD I work with, and my favorite MA who lives for nasty procedures. Again, the room is small. The room was also hot. And did I mention the stench of the abscess? Can you see where this combination of forces leads?

So, prep, anesthetize, cut, express, express, express, express, express (you get the idea), whiff, feel faint, get hot and clammy, realize you are about to hit the deck, call for back-up, sit, regain composure, express, pack, cover. Try to get the smell out of your memory. Try harder. Keep trying. Visualize the relative beauty of the cervicitis. Thank the heavens for bullshit URI appointments.

And a tip: for those who are also new to abscesses, my MD told me that the pH of the pus weakens the effect of the lido so numb 'em up somethin' good! Happy draining!