Monday, May 19, 2008

Home sweet home

NewFNP has just returned from a glorious long weekend with her graduate school pals. She ate good food, hung out with her friend's kids - one of whom called her Frank Gehry fish necklace a 'banana phone', drank too much wine and shopped in a very hipster area of an across-the-county metropolitan area.  It was a great weekend and newFNP misses her dear friends already, but it sure feels lovely to cross the threshold into one's own apartment.

Before newFNP departed, she checked in at the hospital where she had transferred her HIV+ patient.  He was admitted for presumptive PCP and was still spiking temperatures.  He was set to receive a blood transfusion for a hemoglobin of 7.2.  He was in isolation due to concern for TB.  

This is the guy that the paramedics gave newFNP a hard time about?  One of the paramedics actually asked newFNP, "Well, did you listen to him?" when she told him of her PCP suspicion. No, dickhead, newFNP makes it a practice to not examine her patients prior to calling for EMS. The vast majority of the paramedics are so great and sort of participate in the group effort we all undergo to attempt to keep our patients well/alive, but this interaction brings to mind another frustrating experience with EMS.  Last time, the asthmatic kid was admitted for several days.  This time, her patient is still in the hospital.  She talked to his nurse this morning.  IV Vancomycin Q8 hours and still spiking temps.

NewFNP wishes that she wasn't right about this one.  But she also doesn't want to have a fight in the hallway with the stubborn paramedic.  NewFNP - believe it or not - is trained to make decisions such as when to send patients to the hospital and she doesn't want to duke it out in the hallway.  And, with this guy, she got the distinct feeling that he just wanted to blow off the transport and make a point of questioning newFNP's judgement.  Is it possible that he didn't want to transport someone with HIV and a fulminant facial rash with a suspicion of AIDS?  NewFNP hopes that is not the case.  She would much rather have him think that newFNP is a big fat idiot.  

NewFNP wishes that she knew more about HIV management.  Of course, newFNP would not be able to provide such services in her clinic without social work and drug assistance and support for remaining clean & sober.  Nonetheless, newFNP feels like her HIV management knowledge hits an abrupt wall soon after diagnosis.  Perhaps a good CME topic.


Anonymous said...

In 20 days, I will graduate from an FNP program. Up until just recently, I've felt very confident, but now I am panicking because I don't feel like I know anything. I've been reading your posts for a while, and you give me hope, and you also make me feel like I'm not alone. Thank you!

Rick said...

I'm planning on going into a FNP program in a few years. Great to get a reality check about what it will really be like. Love the blog. Keep up the great posts!udent

Anonymous said...

curious- was the pt started on ART recently? Immune reconstitution syndrome comes to mind if that was the case- especially if he was started with very low CD4 and high viral load. TB often blooms in this scenario- as can many other OIs.

newFNP said...

He still isn't on any HIV treatment and is still hospitalized. NewFNP is working on finding him housing, case management and medical care. His AFB was negative but he was treated for pneumonia. His nurse was very unhelpful and would not tell newFNP what type of pneumonia. Boo!