Hold the mayo

There are days during which patients just break newFNP's heart.

Imagine having gone through a fetal loss, an ectopic with subsequent tubal scarring and years of infertility before finally meeting a reproductive endocrinologist who will work with you when you're uninsured. Imagine being evaluated for Clomid and preparing to start using it. Then imagine finding a breast lump. Then having a fine needle biopsy with a "bad" result. And then imagine the waiting between those results and your impending excisional biopsy, when you have nothing to do but think of how you're not pregnant and how maybe you have breast cancer just like the beautiful woman sitting next to you in the breast clinic when you had your needle biopsy.

And on top of all that crap you get a cold and end up in newFNP's care. Son of a bitch, right? That's just what you need!

NewFNP breaks the touch barrier a lot. She believes that a handshake or a simple pat on the back or the arm goes a long way in welcoming patients. NewFNP took this patient into her arms today as she sobbed.

So, yes, there are days when patients just break newFNP's heart. Of course, there are also days during which patients just bust newFNP's chops as well.

Today was a combo platter.

Fine art

NewFNP has no personal opposition to tattoos. In fact, she must admit to having had a certain attraction to some tattooed gentlemen now and again. In fact, it has been rare - if ever - that newFNP has felt morally and personally offended by a tattoo. NewFNP supposes that there is a first time for everything afterall.

While conducting a physical exam, newFNP noticed that her patient had half of a buxom naked lady peeking out from under his mid-calf-high gym socks. Not only was this lady stacked, she was also sitting with her legs widely spread, knees bent. Although her nether regions were covered by the gym sock, newFNP had a guess as to what was hidden beneath. Well, in case newFNP was wrong in her assumption, when she walked around to the patient's side, she got a glimpse of something she had never imagined anyone - save for disgusting perverts - would want eternally portrayed on their external calf.

NewFNP must confess that the artist was clearly a student of the female external genital anatomy. Professional or lay, this tattoo artist knew his stuff. NewFNP can't be certain, but she thinks that she saw a Skene's gland. In any case, is it necessary or even desirable to have a 7-inch tall tattoo of a naked and anatomically accurate lady in the doggy-style position, fingering herself , and glancing longingly over her shoulder? NewFNP thinks decidedly not.

NewFNP has thought about this a lot - not the tattoo, per se, but her reaction to it. A) NewFNP felt offended. Period. B) NewFNP did not want to continue to provide much care to this individual who clearly has low regard for women. C) NewFNP felt sorry for this person's daughter.

Maybe newFNP should have suggested tattooing underpants on the lady. Or maybe she could have just said, "Oh - I see you have a fucking repulsive tattoo. Do you have a difficult time getting laid?" But she didn't. She just did a quick exam and moved on to the next 50 million patients that day.

Gross.

But it's 4:53 PM

Here is the patient who should be the 4:45 walk-in: tinea, 1 lesion. That's it. You have ringworm, welcome. Please come in and accept my anti-fungal treatment. And then leave so that newFNP can too leave in order to make it to her overcrowded, under-air-conditioned gym prior to all of the elliptical machines being hogged.

Here is the patient who should not be the walk-in at the aforementioned time: the never before seen in our clinic 63-year old lady with the visibly pulsating carotid. It wasn't small, nor was it subtle. It was reminiscent of the boils on the truck driver's neck in 'Harold & Kumar Go To White Castle,' a must-see movie as far as newFNP is concerned.

In considering this patient, newFNP has but two words: time bomb.

Carotid bruit? No. Hugely wide carotid with a loud - and newFNP does mean loud as all getout - pulse. Is it an aneurysm? Possibly. Whatever it is, it needs more in-depth evaluation than newFNP's little community health clinic can provide. And did I mention that her BP was 144/40? Well, it was. NewFNP likes to call that a "wide" pulse pressure.

So, to sum up: wide pulsating carotid + wide pulse pressure = good-bye pulsing neck lady. Enjoy the ED. NewFNP sincerely hopes that this trip will save her patient's life.