Tuesday, November 27, 2007


Seriously, what the fuck happens to people over a holiday weekend? NewFNP is gone for four days and the whole world goes to pot.

NewFNP is continuing her week of meaningful encounters, which is lovely and, given newFNP's semi-cynicism, oddly life-affirming. NewFNP is not one to curl up and hug one's inner child, but it has been making her feel good to do good. Because, you know, she is so used to doing evil.

But newFNP just wouldn't be newFNP if she didn't talk about a jacked up penis, so let's get on it. Figuratively speaking, of course.

There is something to be said for having the parent in the room for at least part of an encounter with an adolescent male. For instance, when newFNP asks something along the lines of, "How can I help you today?" and the kid responds, "Oh, you know, I had a headache a few months ago," newFNP is appreciative when the mom jumps in with something like, "And you were hemorrhaging from your penis and went to the ED."

OK then. Let's get down to business.

When newFNP sees a 16-year old guy with a hickey the size of Wyoming on his neck and hears about penis hemorrhages requiring trips to the ED and stitches, she has two differentials: aggressive masturbation or buck-wild teenage sex.

In order to screen for other risky behavior, newFNP asked, "Were you having sex when this happened?"

"Noooo!," he responded, a look of horror and shock on his face. "It was in the morning!"

Ah, to be a teenager and not yet have experienced the beauty of the morning sex. NewFNP had to grin.

Apparently, he just had to pee really badly and then all of the sudden, his foreskin just blew up like a fucking landmine and his penis started bleeding like he was beating off with Freddy Kreuger's scary blade-hand. Yeah, buddy. Whatever you say. NewFNP will just send that urine off for GC/CT just to be on the safe side. She feels somewhat assured that this young patient will not be having sex anytime soon -- at least until the fucking penis stitches dissolve.

Monday, November 26, 2007

In memory of J.L. 1927-2007

NewFNP hasn't had a patient die since she was in training.

Today she received news of her first patient death. She got a phone call from the funeral home, letting her know that her 80-year old patient with cor pulmonale had died over the Thanksgiving weekend and would she sign the death certificate? Alas, as an NP, she cannot but her MD co-worker would.

He died at home in his sleep on Saturday. On Friday evening, he told his son that he thought he should come on in to the clinic the next morning. His son found him the next morning, "cold" in his bed. This same son came to clinic today just to stop by and thank you to newFNP for the care she had provided. It was incredibly touching.

NewFNP often felt as though she hadn't done much to help this old gentleman. Sure, she wrote his O2 and furosemide prescriptions and closely followed him and his lower extremity edema. But what newFNP remembers most about her appointments with this guy and his son, totalling maybe five over the past year or so, was that she smiled when she walked in the room because he was easy to smile at, that she answered his questions when he had them, that she sent him to the ED at the right time early on in his care at newFNP's clinic. He joked with newFNP with the ease that only elderly men have with far younger women: playful yet appropriate, full of vibrancy and mischief.

NewFNP doesn't spend a lot of time reflecting on her role in her patients' personal histories, but she very much is. The manner in which she cared for this patient exemplifies how she wants to practice with all of her patients. While it is perhaps an unattainable goal in her current place of employment - given systems failures that are far beyond her control and her own variable capacity to control her frustrations - she would like for all of her patients to leave their encounters feeling cared for.

After all, there are many ways in which to care for one's heart.

Sunday, November 25, 2007

Feelin' good, feelin' *real* good

NewFNP's four-day wonder-weekend is winding down. Thus, newFNP forced herself to return to her normal Sunday routine of gym and a trip to the farmer's market.

While at the gym this morning, newFNP was perusing the current issue of The Journal of Family Practice and stumbled upon an article which sought to elucidate the role between marijuana use and the use of Viagra (sildenafil). Although the sample size was only 231 and was only selected from one outpatient practice in Brooklyn, fully 59% of the Viagra poppers did not have diagnosed ED. They were, in fact, recreational users of the little blue pill. Of this sample, 76% of them admitted to feeling a kinship to Snoop Dogg, not in relation to weapons charges or hos, but to loving themselves some weed. These stoners also noted that they sometimes procured their Viagra from "friends" or "street vendors." NewFNP is so worldly in some ways, yet so naive in others. She was just not aware that a market existed for this type of prescription drug.

Maybe A&E will do an "Intervention" about it. NewFNP imagines that the actual intervention would contain the plea, "Your ridiculously hard penis is ruining our relationshop! We never go out, we never invite friends over - we just sit around and smoke weed and have sex because of your crazy penis! I can't take it anymore and I will no longer enable you with my multiple orgasms!"

It is a stretch for newFNP to remember the days when marijuana played any role in her life, but it would have been when she was in high school and, frankly, newFNP is quite certain that - weed or no weed - teenagers are going to have sex. After they eat some Hostess and Taco Bell. Therefore, newFNP thinks that the population polled for this study is older, say in their 30's-50's, although age was not reported on.

NewFNP found the article amusing and appreciated that someone had to think of the research question in the first place. It really begs the question of the researcher, "What was that guy smoking?" Additionally, the article brought up the following questions for newFNP.

1) Who are these middle-aged guys who smoke weed? Do they still live in their parents' basement watching Soul Plane and playing air guitar, or are they just normal guys with girlfriends or boyfriends or wives and with careers and college educations? NewFNP hypothesizes the latter, but is willing to allow that the former do exist as well.

2) Where do these people buy their weed? NewFNP isn't all D.A.R.E. and Nancy Reagan, but she would be scared as shit to get busted. NewFNP will just stick to red wine. Unless you know anybody. Kidding - geez, calm down.

3) Are these guys popping Viagra because their libidos are diminished from the mary jane? Or are their libidos diminished by the paranoia that their special friends are in the DEA? Or because their ladies are all red-eyed and messed-up-haired with powdered sugar from the 6 Hostess Donette Gems she just consumed all over her t-shirt ? Or do these guys just want to experience more pleasure? Here is newFNP's null hypothesis: weed smoking = love of feeling good. Sex feels good. Maybe it just feels better when you're stoned and hopped up on Viagra.

4) Why do we still care if people smoke marijuana and why is it illegal? Just like the OGs say - regulate, motherfuckers, regulate. Don't drive stoned, don't get stoned while you're hanging out with your kids in the jumpy house at the neighbor kid's birthday party because, even though you'll really want to, you can't go in. Just think of the tax revenue we could create of we added a tax to your pack of joints? The schools would benefit! The food industry would certainly benefit. While we as a country, astoundingly, cannot seem to get behind gay marriage and tighter emissions standards, maybe we could all join hands, pass the duchey on the left hand side, and demand that we don't criminalize our weed smokin' fools!

Wednesday, November 21, 2007

Giving thanks.

NewFNP is often flippant and irreverent. She can, however, be ruminative as well and would like to take this time to note some of the things for which she is grateful. Only some of them will be flippant and irreverent.

1) Four consecutive days off for the Thanksgiving holiday. The Thanksgiving week is newFNP's favorite work week - it's three days!! Even newFNP can manage to smile for three days. OK, mostly. NewFNP is almost unsure how she will spend her Thanksgiving mini-break. She will not shop, although she loves to, but will just enjoy her time off and attempt to be mindful of just how fortunate she really is.

2) Literature. NewFNP loves to read. She intends to read a lot these next few days. She may shop, after all, but only to buy a highly recommended new book.

3) Friends. Friends who don't think she's a lame-o when she cries to them about love gone awry, who feed her well and ply her with good wine, who go on hikes with her, who laugh at her jokes and make her laugh in turn, and who just let newFNP know that she has a place in this world. NewFNP will be attending a potluck tomorrow. Some of the people are new to newFNP, others old. How lovely to spend a day eating potatoes and pie, and sharing one's life. And eating again.

4) Pie.

5) Family. NewFNP has had a lot of family time this year and a lot of fucking devastatingly sad changes. Her family has been through so much. NewFNP wishes she could be with them, but to do would mean breaking her longstanding prohibition against Thanksgiving holiday travel. She broke her self-imposed rule for Thanksgiving 2005 and believes that her ass might be extra-flat as a result of the fucking long drive.

6) Trouser jeans. Joe's Jeans, can you do no wrong? Your fits are amazing and your trouser jeans with patent leather trim on the pockets are divine. NewFNP is truly thankful for their flattering fit and reasonably lengthed inseam.

7) Paycheck. Without it, how would newFNP afford said fashionable Joe's Jeans?

8) Contact lenses. NewFNP suffers from extraordinarily poor vision. How would newFNP sport her perfectly over-sized Tom Ford lunettes de soleil if not for her contact lenses?

9) Retin-A. She has said it before and she'll say it again. NewFNP cannot extol its virtues enough. Why is not every 29-year old at their dermatologists demanding this prescription? Give up on the Creme de la Mer and get thee to thy derm!

10) Her readers. Seriously. Thank you for being interested in what newFNP has to say and for coming back for more.

Happy Thanksgiving.

Monday, November 19, 2007

Get me out of this thing!

NewFNP infrequently finds herself in the position of being a patient. Yet she found herself dialing the on-call physician for her practice last night, her wrist pain registering an 8 on a 10-point scale. She had fallen earlier in the day while hiking, thinking only her pride wounded, but as she palpated her very own anatomic snuff-box and brought a tear to her very own eye, she knew that something was woefully awry.

NewFNP patiently waited for Dr. On Call to call her back and was pleased when he did so promptly. NewFNP often feels a bit guilty when she is on call and attempting to do over-the-phone triage. It requires the patient to make a decision about their needs, to weigh the benefits of emergency room care over waiting for a clinic visit. Sometimes the answer is clear cut, others fall into the category of "art" rather than "science."

NewFNP's on call provider essentially told her that, yes, she needed an x-ray. No one wants to miss a scaphoid fracture, what with all its risk for avascular necrosis and non-union even when frigging treated! But did she need to go to the ED right then? NewFNP struggled with this.

For one, her ED co-pay is a Benjamin, whereas her office co-pay is a Hamilton.

NewFNP is all about the Hamiltons, baby.

For two, what was a trip to the ED really going to do? X-rays, maybe a splint. Was newFNP going to see a hand surgeon at 10PM on a Sunday? Was she going to get casted? No, she would be instructed to follow-up with the appropriate provider the next business day.

And finally, would newFNP be entirely truthful if she omitted the momentary thought of leaving work early in order to see her own primary care provider? She would not and newFNP is nothing if not honest. And fashionable. And stuck on this Sunday's NYT crossword puzzle.

In the end, newFNP decided that her x-ray could wait. But newFNP has years of education and practice under her belt and had the requisite knowledge to really weigh her options.

She was, however, unsure in her decision as she struggled to unhook her own brassiere prior to retiring. Can you imagine the panic - frantically struggling to unleash one's heaving bosoms from their support in order to repose without wires and cleavage? Agonizing. In the end, newFNP was able to shimmy her arms out, rotate her band around and unhook in front just like her 92-year old grandma does.

NewFNP is in great hopes that the humiliating extraction from her t-shirt bra will not be replicated in the upcoming weeks (months?) if newFNP is in a fucking spica cast. To her moderately-trained eye, the x-ray looked fine. To her internal med (handsome yet pleated pants wearing) doctor, the films were lovely. Now we wait for the radiologist to keenly examine newFNP's scaphoid and deliver the real diagnosis.

Tuesday, November 13, 2007

Once is never enough. Unless.....

If newFNP were to be flippant, she would counsel that if you have to acquire an STI, chlamydia is the way to go. Think about it, 1g of Azithromycin and, if you treat it early, you're likely good to go. This is in contrast to say, Lymphogranuloma venereum, which is, in fact, caused by C. trachomatis but appears to be much, much worse. Or ophthalmic gonorrhea in which your eye tries to kill itself by drowning itself in pus.

OK, enough of that fun mental image and back to chlamydia.

It's no big epidemiological secret that chlamydia is widespread in young sexually active people, much like their legs, newFNP presumes. NewFNP treats it on a fairly regular basis. In addition, she dispenses partner therapy in order to nip that drip in the bud.

So when newFNP diagnosed her new prenatal patient with chlamydia on her routine OB labs, she happily dispensed an extra gram of azithromycin for this young woman to give to her partner. She counseled pelvic rest for at least a week and instructed this woman to come back three weeks later for her routine OB physical and pap.

She returned, and guess what else did?

Where newFNP must have failed was in not dispensing an extra dose to treat her partner's partner. NewFNP will find out tomorrow when her patient returns for a second course of treatment and, perhaps, some frank discussion regarding the asshole who is re-infecting her.

Sunday, November 11, 2007

A little help here, please.

NewFNP has been living in her major metropolitan area for over two years. She, for the majority of that time, has had a boyfriend. She has now been single for approximately four months. She has had not one date.

OK, sure, her dating life was theoretically complicated by the fact that she and her Punjabi ex-boyfriend were still living together, but that apparently would have made absolutely no difference whatsoever.

NewFNP was pondering her sad state of affairs when a young woman came to newFNP's clinic on Thursday, in need of some help with her lady business. You see, she had moved from Texas three weeks ago and now was having vaginal discomfort. Three weeks! That was all it took for this lady to get both a boyfriend and an STI.

Seriously folks, three weeks? Granted, newFNP would rather keep her downstairs free from the utter mess that she saw in this woman's vag, but for Pete's sake! Three. Frigging. Weeks.

There are many things that newFNP does not understand in this world. For instance, why does newFNP's front desk staff continually allow patients to be roomed without charts when they have appointments for follow-up? How does someone move from another fucking state and have an immediate, albeit undesirable, hook-up? Why is Designs Within Reach so named? How is a $3000 Le Corbusier cowhide lounge chair within reach? A little off topic, sure, but something about which newFNP has spent many hours considering.

In case any newFNP readers were curious as to the state in which newFNP lives, that state is celibacy and newFNP needs a change of venue!

Monday, November 05, 2007

Respect my authority!!

Prior to her current role, newFNP has never really been in a position of authority. Sure, she has been an authority on clear skin and flat-front pants for the fellows for some time now, but these things did not carry with them the burden of being feared, being disliked or being the target of shit-talking as a result of asserting her authority. Not even when then-studentFNP threw her law school pal's pleated pants across his apartment in fashion protest did her authority engender such strong responses.

NewFNP readily admits that she has an exceedingly low tolerance for incompetence and laziness. She values initiative and intelligence. She can see that these are her own values and can own her own shit, therapeutically speaking. This does, however, make her experience at work challenging at times.

But one would think that newFNP was in league with Pol Pot or Idi fucking Amin with the way the shit talking has been flying lately. NewFNP finds it bothersome.

When newFNP's MA asks her in which room she would like to see the prenatal patient and newFNP responds, "room 4" and then heads off to room 5 to see another patient, that is not yelling, nor is it saying that she no longer wants to see patients.

Likewise, when newFNP instructs the same MA to put one of the two 3PM adult physicals in with the other provider, that is neither yelling nor is it refusal to do one's job. It is a little something that newFNP likes to call "sharing the burden."

NewFNP's clinic manager and other MA basically just counseled newFNP to shrug it off. The exact words might have been "Fuck 'em."

NewFNP sort of agrees - who the fuck cares? Talking shit about one's boss is natural, healthy and fun! But newFNP is, in fact, no one's boss and she just wishes that they would all save the shit-talking for after 5PM.

This crap on a day when newFNP showed up bearing gift cards to thank staff for having Halloween spirit and dressing up! Lame.