Wednesday, June 11, 2008


In case anyone missed the memo, community health is challenging.  It's not only that patients are ill and uninsured and have more medical and emotional needs that the clinic and any given provider can reasonably handle.  

It's also that the patients just don't 'get' the system.  

For instance, newFNP had a charming but terminally ill seventy-five year old woman walk into clinic today.  The woman has cancer.  How does newFNP know this?  Well, it helps to have pathology reports noting lung cancer and metastatic adenocarcinoma.  However, even without the reports, newFNP wouldn't have missed this one.  

She wasn't on oxygen, she didn't have a tracheostomy.  So how could newFNP have known that she had cancer?  Did she call Miss Cleo's psychic hotline?  Does she have x-ray vision?

Nope, it's because the woman had two huge visible tumors.  One was on her anterior chest wall, about the size of a baseball and just as hard.  The other was on her abdominal wall.  It was rock hard as well... and draining.  And it was large.  Really large.  Hugely crazy large.  Bigger than Posh Spice's fake boobs.  NewFNP is talking 8-by-6 inches large.

Now, this woman has known since January that she has inoperable cancer.  And where might her oncologist be?  In a state some twenty-five hundred miles away from newFNP's clinic.  She stated that she got bored and just wanted to get away.  NewFNP appreciates that, if one is dying, they should do whatever the hell they please.  Travel the country, visit the ghetto!  

But just one thing - get your oxycodone refilled before you leave.  

As newFNP has previously noted, the walk-in scheduled med refill is not one of her favorite visits.  But when you have very obvious cancer, newFNP doesn't even think twice about writing that oxy prescription.  Knowing what lay ahead for this woman, newFNP accompanied the prescription with a referral to the palliative care team at our local public hospital.  

1 comment:

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