Wednesday, April 09, 2008

A little something extra

A huge factor in newFNP's deciding to become an NP was her desire to help people.  This is not unique, of course, but sometimes newFNP gets so bogged down in the B.S. of day-to-day clinical life that she sometimes loses sight of this.  

But then a patient comes in and reminds newFNP why she's there.

NewFNP has a lovely patient who was diagnosed with metastatic choriocarcinoma after presenting to the ED with weakness and a hemoglobin of 3.  After her hospitalization, resection and chemotherapy treatment - which took place at a very fancy-pants hospital - she lost her job of fifteen years and, with it, her health insurance.  She was no longer able to get her regular monitoring at the same hospital.  Because her tumor was hCG-responsive, she needs to have her hCG checked monthly which is how she ended up at newFNP's clinic about a year ago.  

Understandably, when this patient met newFNP, she was also being treated for depression. Cancer, job loss, two young daughters and a precariously employed husband.  Yeah, depression and hopelessness seem reasonable.

NewFNP has seen her several times throughout the year for episodic concerns as well as for her monthly monitoring.  Generally, she has been physically and emotionally healthy.  Today, she finally made it in for her well-woman exam.  Like all of newFNP's patients, this patient worries a lot about money, a concern that has become more salient recently.  Like all of newFNP's patients, this woman needs insurance.  Unlike all of newFNP's patients, she is bilingual and has a social security number and computer skills.  

So newFNP did her pap, listened as she cried and disclosed her concerns about financial woes. She would like to restart her anti-depressants.  She needs her hCG drawn and the result faxed to the fancy hospitals department of gyn-oncology.  She hasn't had the chest x-ray for which newFNP referred her nine months ago because it is just too expensive.

At some point in this encounter, newFNP realized that there has got to be a job somewhere in the five-clinic organization for which newFNP works.  This patient certainly would not be the first to transition from patient to employee - three of newFNP's current MAs were former patients at the clinic!  NewFNP excused herself after completing the exam and asked her clinic manager if he knew of any openings.  In fact, he did.  A brand new clinic was looking for an IPA case manager.  NewFNP brought him into the room and talk to the patient.  

As far as newFNP can see based on an n of one, an IPA case manager works about 50-65% of the time, coordinates fast food restaurant lunch selections 10% of the time, is on the internet 10% of the time and chats with work pals the remaining 15-30% of the time.  There is no way that a forty-something year old cancer survivor cannot do better than that!

Today, this patient left our clinic having received a pap, her regular post-choriocarcinoma monitoring, her mammogram referral, her calcium and physical activity recommendations, and with an application for employment and contact name in hand.  

And she left with a hope and a smile.  

NewFNP knew as she raised the possibility of employment that there was a chance for disappointment.  But sometimes we just have to take chances and, dare newFNP say it, have a little faith.


Beth said...

kudos, great job!

Anonymous said...


RN2CNM said...

You Rock!!!
I just stumbled upon your blog but am thoroughly enjoying it.
I'm in school for MSN, not FNP though, and really loving reading through your experiences.