NewFNP got totally bitch-slapped by the universe.
Friday, October 24, 2008
Two months ago, she placed an IUD in a 38-year old G7P8. This woman was certain that she was done with childbearing and that the IUD was preferable to a BTL. NewFNP is privy to this woman's complicated social history and agreed that an IUD was a good choice. We reviewed adverse effects and benefits, signed informed consent and went for the placement at the next visit.
The insertion went smoothly, as one might expect with a woman who has had 8 vaginal deliveries - even of her twins. That was the last smooth experience newFNP has had with this client.
The next day, she returned to the clinic stating that she wanted newFNP to remove her IUD. She had read the entire pamphlet and was disturbed to learn that women may have tubal pregnancies with the IUD. Yes, newFNP explained, but women are at risk for ectopic pregnancies anyway and lowering your risk for pregnancy also lowers your risk for tubal pregnancy. While her patient was surprised to learn that women could have pregnancies outside of the uterus, she was nonetheless unsatisfied with the IUD and wanted it out.
NewFNP said no.
She encouraged her patient to give the IUD some time, to think about the risks to her family and to her mental health, to say nothing of the AMA-related risks, if she were to have another pregnancy. NewFNP told her to give it 3-6 months and if she was still unhappy, then we would again talk about removing the IUD.
She has been back three times since then. Twice, Dr. Dual-Ivy-League-Degrees told her the same thing. The third time, the new all-around-feather-ruffling doc told her to come back in a week and someone would take it out.
She showed up the next day and waited for five hours for her three minute IUD removal. NewFNP was all bunched up about taking it out and thought it would be a good learning experience for her PA student to take out the frigging thing.
Before everyone gets all up in arms, 0f course this patient has the right to use or not use whatever family planning method she would like to use. Of course she can have as many pregnancies as she wants to have. But she doesn't want to be pregnant and she hasn't exactly excelled at contracepting in the past. And now she wants to use "gel" to avoid pregnancy. What? Gel? Like hair gel? Gonna put some TRESemme up there? Gel??? What about a fucking condom?? The pill? The ring? The patch? The shot? A diaphragm? A tubal ligation? There are many effective methods but gel, sister, is not one of them.
So newFNP did some alternative method counseling and got her student set up to remove the thing, fuming inside about this utterly failed attempt at decent, reliable contraception and feeling a little pissed that she was taking the IUD out. As she maneuvered her student's instrument tray, newFNP backed up - ass-first and slightly bent over in order to visualize what her student was doing - and hit her butt on the corner of the counter in the exam room.
Oh, the velocity of her movement. NewFNP does not know her own strength, even when conducting a seemingly benign activity like backing up.
A shockwave ran down her leg and up her spine. She wanted to cry out "Mother fuck!!!" but she didn't want to entirely destroy the already shaky encounter. If this were a different kind of site, newFNP would post a picture of the impressive purple bruise that has caused her untold pain and has served to remind her about that shithole of an encounter and that her patient can do whatever she wants for birth control, that it's newFNP's job to educate, guide, encourage and prescribe, and that she should just keep her judgments to herself and take that fucking IUD out and move on.
NewFNP knows all of this but she does want to point out that this IUD costs around $500 and that its cost-effectiveness is really not seen when someone has it for two freaking months.