Thursday, October 18, 2007

Exam room 6, ready for seating

NewFNP hasn't commented on obesity lately, but she cared for a patient who got her thinking. This patient has a BMI over 60. Although newFNP is no Mavis Beacon, BMI >60 is no typo. This patient came in for various complaints, including abdominal pain. Let's just call newFNP's exam "limited by habitus."

This patient also noted lesions in her skin folds. NewFNP has treated fungal intertrigo in this patient before, but has not seen her in well over a year. Perhaps if she would have, newFNP might have stopped the awful maceration to this patient's thighs, pannus and buttocks. NewFNP hasn't been doing weights lately and it showed as her arm was shaking in an effort to hold back the pannus in order to examine the extent of the damage.

And can newFNP say it once again, ladies? If your BMI is over 60, your lady parts are also going to be fat. And when those lady parts get fat, the picture is oh-so not pretty. And when you have macerated abdominal, thigh and groin-adjacent skin, it is, quite frankly, time to hang up the bikini underpants and find peace with the big cotton grandma bloomers.

Seriously.

But what really struck newFNP is how demoralizing it must be for this patient to come to the clinic, to have newFNP struggle to hold back her obese belly and to have newFNP counsel her on the merits of the grandma panty. How she must feel some amount of shame every day regarding her weight. How every activity must be a struggle for her. As horrifying as the physical effects of obesity are, the emotional effects must be comparably devastating. NewFNP felt a combination of honor and horror when this patient asked her if she would do her pap. On the one hand, she must have felt respected and cared for by newFNP. On the other hand, that is going to be one hell of a pelvic exam.

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When newFNP was in public health school, she had this frigging awful narcissistic professor who informed the students about her success as a physician, model, poet and basketball player, ad nauseam. She also took away our break, probably because she knew that we would talk vicious shit about her, not only to read us her crappy poetry, but also to make us exercise. We hated her for it. This was, after all, public health school. The majority of us had already had our morning workouts before we came to her piece of shit class. NewFNP isn't saying that she is going to adopt this as a practice, but that she must admit that she has considered finding a far less offensive way to encourage physical activity in the waiting room. After all, the patients may be sitting there for hours.

Perhaps newFNP's clinic should buy buzzers a la Cheesecake Factory. The patients can then go exercise and we can buzz them when their exam room is available!

1 comment:

Loving Pecola said...

I really liked this post for its balance of your feelings about the patient. And as a midwifery student who does paps all day at clinical, I agree that it is an honor for someone to specifically ask *you* to be the one to do their pap. I have only done one pap on an obese woman, but it went just fine. The only difference was doing the bimanual...after you lift the belly to put your hand on the pelvis above the mons pubis, the belly fat falls back down over your hand which feels...weird and heavy...and makse the "smooth motion" of feeling for the uterus awkward and almost impossible because the belly fat is heavy on your hand and the other hand is inside of her and can't help you!

A good pelvic exam can make a woman's day...good luck!

LP