Friday, May 26, 2006

A plea

Ladies, please - hear me out.

Now, newFNP knows that all members of the fairer sex will at some point be afflicted with nipple hair, or more specifically, peri-areolar hair. NewFNP is not of hirsute stock, yet even she has had to endure this hardship. But what makes this tragedy something one can easily overcome is a little something called tweezers, a not-so-new technology. NewFNP opts for Tweezerman, but she is sure that even Revlon makes a pair that would be suitable for boob tweezing. Especially when your nipple hair is coarse like a man's and two inches long like a certain recent patient in clinic. So, please, cut newFNP some breast exam slack and tweeze.

Disclaimer: newFNP considers herself 100% feminist and does feel some guilt regarding both this post and her aversion to whatever makes her female patients happy as far as breasts go. NewFNP will send a check off to NOW right away.

Right after she sharpens the edge of her tweezers.

Tuesday, May 23, 2006

Oh, to be wrong!

Normally, newFNP enjoys being correct. NewFNP likes good grades and completed NY Times crossword puzzles (only the Sunday magazine crossword, not the NYT crossword). At this relatively early stage of her career, newFNP also enjoys correct diagnoses. When she presumptively treats a strep throat while awaiting culture results, she feels selfishly relieved when the cultures are positive.

NewFNP, however, is not so pleased with her correct presumptive diagnosis in her sweet 68-year old patient. This woman's chief complaint was urinary incontinence, but she also noted a very foul vaginal discharge. Oh, and some vaginal bleeding. Not all the time, but vaginal bleeding nonetheless. The words "post-menopausal vaginal bleeding is cancer until proven otherwise" rang in newFNP's head as she was taking the history.

Other pertinent info:

  • no sexual activity for many years
  • last pap 2004 - patient assumes it was normal
  • vaginal discharge progressively worsening over 6 months
  • vaginal bleeding times 4 months - intermittent
It's newFNP's understanding that there are some vaginal infections that present themselves even before the patient is in the lithotomy position thanks to the ol' olfactory system. NewFNP had yet to experience such an infection until meeting this patient.

Although it feels insensitive to say it, newFNP had to choke down her gag reflex during the exam. The odor was reminiscent of abscess contents. The discharge was green and, man alive, was it ever copious! It was literally running out of the speculum as fast as newFNP could swab it.

Now, newFNP frequently wonders if cervical lesions will be visible to the naked eye. Ectropion, sure. But what about those purple lesions? Are they moles? Should I know this? Whenever newFNP sees something she is unclear on, she makes sure to get a nice sample of it for the pap. Well, what this lady had going on was so visible that newFNP had to look at it many times over to actually believe what she was seeing.

If memory serves correctly, the chart note read something like: Gray round lesion, approx 1.5 cm, rough surface, adjacent to cervix at 3:00. Friable.

The referral note states: Rule out gyn cancer. Pap pending.

The pap isn't pending. It was faxed to newFNP today. Squamous cell carcinoma. No BV, no trich, no gardnerella. No GC/CT. All of that discharge must have been necrotic tissue sloughing off.

In the next few days, newFNP will be, for the first time, telling a patient that she has cancer. In Spanish. In fucking Spanish.

It is horrible to be right sometimes. Yet, it does reinforce the adage that seeing enough normals will help you to recognize the abnormals. That, however, isn't enough consolation for newFNP right now.

Thursday, May 18, 2006

What a feeling!

Apparently, newFNP's HR department has nothing better to do than to come up with new policies regarding professional attire. There were some expected no-no's, of course, such as a prohibition against shorts and half-shirts. Sorry, Beyonce, no job for you at newFNP's clinic!

There were, however, some unusual frowned upon fashion pronouncements. For instance, it is "inappropriate" to wear khakis or chinos. I'm sorry, but where is it appropriate to wear khakis if not to work? Also not making the cut were clogs, of all things. Sorry Dansko. You'll have to appeal to the Dutch because the community health clinic says you are inappropriate.

The most unusual fasion item to make the "no" list were... wait for it..... stirrup pants! Please, someone tell me, what is newFNP going to wear with her leg warmers, headband and off-the-shoulder sweatshirt? What's next? Outlawing Forenza oversized v-neck sweaters and Members Only jackets?

Tuesday, May 09, 2006


There are times throughout the day during which newFNP sees her patient and immediately senses a "what the fuck" coming on. What newFNP would like to do is gingerly tiptoe backwards out of the exam room, hoping that the patient never noticed that she was there.

Given the state of affairs of one patient today, newFNP could have probably succeeded in the aforementioned exit strategy.

Before continuing, can newFNP just make one more plea to prevent frigging Type 2 diabetes? Yes, yes, we can't save them all, but newFNP is sure as shit saving herself. And if a gaggle of patients want to set sail in the health boat with newFNP, they can hop on board. Ahoy!

Here is why "Develop Type 2 DM" is not on newFNP's to-do list.

A) Renal failure.
B) Proliferative retinopathy/blindness.
C) Peripheral neuropathy/amputation.

And if that weren't enough, newFNP has a new reason to add to her list: Charcot's Foot - a complication of neuropathy that leads to fractures of the bones without having experienced major trauma. Because of the neuropathy, the fracture isn't felt by the patient who continues to walk on the affected foot. This, in turn, leads to severe deformities, sometimes intractable ulceration and the potential for amputation.

If you haven't seen Charcot's Foot before, conjure images of Kathy Bates' character hobbling James Caan in "Misery." That is what Charcot's looks like. It's swollen, warmer than surrounding skin and looks like someone took a sledgehammer to it.

And if that wasn't incentive enough, just think of this: Charcot's Feet cannot wear cute shoes.

Friday, May 05, 2006

Parenting 101

A little about me. NewFNP is not a parent. However, newFNP knows crappy parenting when she is beaten over the head with it.

Take for instance the mother and daughter pregnancy test walk-ins this week. Mom in her late 30's, daughter in her late teens. Mom's test negative, daughter's test positive. Mom relieved yet concerned about having had two menstrual periods the previous month. Daughter devastated, crying, fallen, crushed.

Mom wrapped her arm around her daugher's shoulders and told newFNP that her daugher had been raped in February. NewFNP inquired as to post-sexual assault care. She had none. No health care, no police report. No menstrual period for two months. No knowledge of whether she had been infected with an STI. No counseling.

Mom repeated over and over to the daughter, "It's OK, it's OK." OK? Fourteen weeks pregnant as a result of a rape is OK? No, not OK. Pretty fucking far from OK.

After a 20-second series of "it's OKs," mom turned her attention back toward herself and inquired as to her irregular periods. NewFNP said something polite but dismissive in order to re-direct the conversation to the daughter. Mom played along, but would not be deterred from receiving the answer to her relatively pedestrian query. NewFNP encouraged her to follow-up with an appointment. What newFNP wanted to tell her was to drop it and to focus her attention on the needs of her re-traumatized daughter.

Is newFNP out of her tree or is there a time during which you let your needs fall aside in order to deal with a crisis? Isn't that part of being a parent? That's part of the reason why newFNP is sans child - still selfish, this newFNP! Still putting her needs first.

Speaking of, J. Crew has some cute frigging spring flats. Perfect with smart trousers for clinic-wear!