Tuesday, February 12, 2008

End of the day blues

At the end of the day, newFNP likes the following types of patients: medication refills; normal lab results; well-child visits with vaccines already up to date; hell, even an uncomplicated UTI is fine!

But a blood pressure of 190/110 in room 4 and an as-of-yet undisclosed HIV-positive drug addict/alcoholic in room 5?  At 4:30?  Unacceptable.

Unacceptable and sad.

Again, newFNP will counsel that resisting the lure of daily crack and malt liquor use, coupled with exchanging sex for money and drugs, is a step in the right direction if one is interested in preserving one's health.  

But, even though newFNP's patient knew that she had engaged in some risky behaviors in the past, that did not make it any easier for her to hear the news.  This 6-foot tall, 130-pound woman who smelled strongly of booze sobbed, her face in her hands and her skinny body slumped on the uncomfortable plastic seat in the exam room.  

"Is that why I can't gain no weight?" she asked newFNP.  Could be.  But maybe the daily crack use has something to do with that as well.  Just a thought.

NewFNP frequently uses "we" when she is discussing sub-ideal behaviors with her patients, a la, "Sometimes when we are emotionally distressed, we gorge on mango Mochi" or "Sometimes we over-do it on shrimp dip during the holidays."  Nonetheless, when her patient asked why this was happening to her, newFNP was somewhat surprised to hear herself say, "Sometimes when we have a serious addiction, we trade sex for drugs or money and don't use condoms."  That elicited a nod of agreement from her patient and, truthfully, a little internal chuckle in newFNP.  Yeah, survival sex has played such a big role in newFNP's life.    

NewFNP did her patient's exam: lungs clear, heart regular, nodes everywhere, pap pending.  She drew lab work: CD4, viral load, RPR, heps AB&C, toxoplasmosis IgG, CMV IgG.  She gave her referrals to HIV clinics.  She encouraged her to attempt sobriety.  

It was a tough encounter for newFNP.  She wanted to handle this one right, to be a voice of support and caring in the life of a woman who has clearly lacked these two things in the past.  NewFNP thinks that she achieved that, but it is kind of hard to tell when your patient is drunk, probably has some underlying mental illness and is devastated.

Oh, and newFNP got the other patient's BP down to a marginal 146/95 and sent him on his way with three BP meds and a follow-up appointment.  It sucks to have to have given pretty decent care to one patient to the detriment of the other patient.  Both patients have potentially deadly conditions, both are rather poor at compliance, but only one got a full 45 minutes of newFNP's time.  

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