It is not so often that newFNP has one of those "I've never heard that before" moments. And perhaps a vaginal exam is not the preferable circumstance in which to experience said moment.
Sunday, December 21, 2008
Thursday, December 18, 2008
NewFNP's clinic is breaking an unspoken mid-to-late December rule: keep it slow. Get out to the dollar store for some inexpensive winter-wear or to the champurrado vendor for some must-be-an-acquired-taste thick, greasy, masa-based hot chocolate but let newFNP have some holiday peace.
Posted by newFNP at 9:47 PM
Friday, December 12, 2008
NewFNP regularly screens her patients for intimate partner violence (IPV). It's just one question, usually either "Do you feel safe at home?" or the not so nuanced "Does your partner abuse you?" It is a hard question to ask, but it becomes less hard the more you ask it and more hard when the answer is yes.
Monday, December 01, 2008
It's getting to be the holiday season and newFNP is sure that, like herself, there are many ladies who would like to get spiffed up for the festivities.
Friday, November 21, 2008
Tuesday, November 18, 2008
NewFNP is either the luckiest or the unluckiest mamacita to ever roam the streets of her urban metropolis in a sweet Toyota Prius.
Sunday, November 09, 2008
It is not often that newFNP falls ill, but when she does, said illness tends to knock her on her ass. The convalescence is short, but miserable - especially when it falls on a beautiful sunny Saturday.
Posted by newFNP at 9:29 AM
Tuesday, November 04, 2008
NewFNP expected that Obama would win as she stood in line at the polls early this chilly morning, but she must confess that the win feels so much better than she had imagined. It is exceedingly rare that newFNP tears up when listening to a speech on TV, but tonight was an exception. Two times she got a little misty - once for President-elect Obama's speech, and earlier during McCain's concession speech as well. If the McCain who spoke tonight would have campaigned instead of the meanie who capitulated to his party's rightest wing time and time again, perhaps there would have been an actual Presidential race.
Monday, November 03, 2008
Oh. My. God.
Thursday, October 30, 2008
Again with the Mirena hatin'! Different patient, of course. NewFNP is trying not to take it personally.
Friday, October 24, 2008
NewFNP got totally bitch-slapped by the universe.
Thursday, October 23, 2008
NewFNP had two HPV-related teen pregnancy issues today. Both were really sad and unsatisfying, both to her patients and to herself.
Monday, October 20, 2008
NewFNP is in a bit of a pickle.
Thursday, October 16, 2008
NewFNP is going to let you in on a little secret: she likes clinical practice more than research. That could be because newFNP has an inherent distaste for all things new or it may be because the research clinic is in a slow-as-molasses phase, but newFNP is - and boy does it ever pain her to say it - bored.
Thursday, October 09, 2008
In newFNP's clinic, we are sticklers for identifying prenatal depression. God help you if we diagnose it, but damn it all if we don't assess for it at bloody every visit!
Sunday, October 05, 2008
NewFNP wants to say right off the bat - take that O.J., you murdering, armed robbering, kidnapping motherfucker! Sure, you got away with murder, you SOB, but you couldn't just walk the straight and narrow and the good people of Las Vegas were wise enough to do what the people of Los Angeles could not thirteen years ago. NewFNP supposes that murdering two people loads you up with bad karma. Further felonies do not help.
Tuesday, September 30, 2008
A while back, newFNP noted that she was caring for a pregnant seventh grader who was not on track to win any genius awards. This young woman continued to astound all who came in contact with her throughout her pregnancy, which ended happily - though not without adolescent high jinx - on Saturday.
Friday, September 26, 2008
People, it is no great secret that people have complicated lives. NewFNP has seen a shitload of this in her expanded role as prenatal care provider.
Friday, September 19, 2008
As many of you know, newFNP was in the midst of a crisis when she made the decision to make a change of venue. She was really concerned that she had made a huge mistake in becoming an NP. It was altogether quite unpleasant.
Monday, September 15, 2008
Sunday, September 14, 2008
NewFNP is nervous.
Thursday, September 11, 2008
Thursday, August 28, 2008
NewFNP sees diabetes each and every day. Double digit A1Cs are, sadly, all too common. But she has very few patients who are as bad off as her 23-year old diabetic with an A1C of 15.7. The lowest A1C she has ever had since her diagnosis in 2006 was in the 13's.
Generally, during her all too infrequent clinic visits, this young woman presents with sugars above the limits of detection on the clinic's glucometer. Once, she came to clinic almost unresponsive in a hyperosmotic - hyperglycemic state (HHS) - mouth dry as a bone and in and out of consciousness. NewFNP sent her promptly to the ER. She passed out another time in the supermarket and again, was sent to the ER in HHS. This last time, she felt herself reaching that HHS point and called the paramedics herself. That's good, right? Understanding one's symptoms and acting accordingly. Sure, a little prompter intervention would have been prudent, but newFNP is feeling generous tonight.
She spent a week in the hospital and left with a glucose of 130, according to her discharge summary. She had prescriptions for insulin, but had not been able to afford the medication when she presented to newFNP's clinic the morning after her discharge.
Her glucose less than 24 hours after hospital discharge? HHH.
NewFNP got her to a detectable level after 30-something units of insulin in clinic, did insulin instruction, diet education and sent her to the nutritionist. This was not the first time in three years that newFNP did diet education, but it is the first time that, when her patient told her that she had eaten two tamales and some pancakes for breakfast, newFNP stated, "That is just like putting a gun in your mouth and pulling the trigger."
NewFNP has never been one to respond to or to employ scare tactics, but she cannot tell you how many people have told her that they changed a behavior because someone showed them a picture of a foot with an amputated toe or because they saw their friend suffer from and STD, etc. Others providers have told newFNP that they use the patient's fear of adverse outcomes regularly in their counsling. NewFNP has just always felt that that is an ugly tool. If newFNP's provider would have said something like that to her, she would have thought, "Whatever- screw you." But newFNP said it and saw that her patient heard it - for better or for worse.
OK, so pretty harsh. NewFNP is certain that the nutritionist delivered the message in a more nurturing fashion.
Whatever message stuck for this patient, it really frigging stuck because when she can into the clinic yesterday, her glucose was fifty-frigging-one. In the course of the six hours newFNP kept her in clinic, this young woman consumed a 75g glucola, a 4g glucose tablet, a turkey sandwich, salad, fruit, a second helping of glucola - this time only 25g - and, thanks to newFNP's awesome student, a chicken breast from El Pollo Loco (thanks BC!). During the course of the six hours, her glucose measured between 45 and 215.
What the hell?
NewFNP reviewed how much insulin she was using and if she was using it correctly. She was. NewFNP therefore lowered her insulin doses and have her strict instructions regarding glucose monitoring, ER indications and follow up.
NewFNP likes to be an outlier if it is something like 2 standard deviations above the mean in fashion sense or test scores, but she does not like glucose outliers on either end of the spectrum. And she isn't sure why this young woman is all over the glucose map.
And now she'll wonder about this patient as she spends two luxurious weeks on vacation after only one more eight-hour shift this Saturday. She'll have to hit up Dr. Dual-Ivy-League-Degrees for an update.
NewFNP's service commitment ended today. Her six-figure nursing school loans are forgiven. Now she only has five-figure pubic health school loans with which to contend. Aaaahhhhhh! What a relief.
Saturday, August 23, 2008
NewFNP's CEO signed her final loan repayment form yesterday. Her last full-time day is one week from today.
Thursday, August 21, 2008
For those not in The Biz, a normal hemoglobin in roughly in the neighborhood of 12-16 g/dL. NewFNP is not going to lose any sleep over an 11 or even a 10, but she will assess your gender and diet and overall health and pregnancy status and miserable menstrual periods and history of hemoglobopathies, yada yada yada.
- Repeat abnormal values.
- Work with the same MA so that you can teach him/her abnormal values that necessitate your attention. The same MA who blew newFNP off when she asked her to repeat the hemoglobin also let a post-CVA hypertensive woman sit in the lobby for two hours after having recorded a blood pressure of 198/110. NewFNP was displeased.
Friday, August 15, 2008
There are a great many things that newFNP does not want in her ears. Wall-o-wax and slurpy tongues come to mind, but much, much higher atop that list is anything on God's green earth that has an exoskeleton.
Wednesday, August 13, 2008
NewFNP is reading an article about burnout and she sees herself in it far too frequently.
Monday, August 11, 2008
Saturday, August 09, 2008
EMS presence has been a regular feature are newFNP's clinic recently. The trend started last week when newFNP had two ambulances at the clinic at the same time - a first for newFNP.
Saturday, July 26, 2008
NewFNP is no expert in mental illness, but she does know the difference between normal behavior and off-one's-rocker.
Tuesday, July 22, 2008
NewFNP felt the magnitude of her decision to leave her clinic as she saw the crestfallen look on her clinic manager's face when she told him that her last full-time day is fast approaching. It's not that she didn't imagine that the transition from community health to academic medicine would be insignificant; it's just that she is ready to leave and has only been focusing on that. But to see this young man's shock and disappointment, to hear him say, the patients are really going to miss you to have him say that he is sad - ouch.
Monday, July 21, 2008
When newFNP started this little blog, she had fully intended for it to provide some helpful hints to new NPs and NP students, rather than solely using it as a sounding board for complaints and to vent her own personal frustrations. To that end, newFNP would like to share a case with her readers.
Wednesday, July 16, 2008
A while back, newFNP saw a guy who came into the clinic and was quite distressed about the painful ulcer he had on his penis. He somewhat bashfully showed newFNP the lesion which required him to retract his foreskin. What was revealed was a bright purple glans with a single ulceration.
Saturday, July 12, 2008
iWhen newFNP was in grad school, she had a dear friend - who shall remain anonymous - who visited an out of town ex-boyfriend under the pretenses of rekindling an old romance. Upon arrival, it became clear to her that she was not going to having any knight in shining armor moments with this guy. Why? Because despite the fact that she flew some distance to see him, he had made plans with another ex-girlfriend for the same frigging weekend! When her pal called, incredulous, and related the story to newFNP, newFNP came up with a plan.
Thursday, July 10, 2008
NewFNP is a broken frigging record. She is burnt out. No, she is charred. She is unrecognizable.