Friday, October 24, 2008

Back that ass up

NewFNP got totally bitch-slapped by the universe.


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.  

18 comments:

SMT said...

She should have read the entire pamphlet before you inserted it. That woman sounds ignorant.

Anonymous said...

To my shock and chagrin I recently had to remove a Mirena after two weeks because pt felt it was giving her "wicked headaches".

No degree of explanation about how IUDs do not have enough hormonal "oomphf" to cause headaches got through.

Later the second, third, and fourth women with similar complaints did not suprise me as much but my mind is still blown...

Candi said...

Oh my gosh!! This was hilarious. I am 36 & will be starting school in the spring & will be a "New" FNP in about 4 years at (I can't even believe I'm saying this) 40! I am adding you to the blogs that I follow RIGHT now!!

Anonymous said...

I think that IUDS are amazing, but patients minds can play so many tricks on them....at our clinic, we do take out maybe 2-3 for every 10 we put in (eventually) mostly because of what I like to call "mental discomfort" and the main complaint is that a patient is convinced that their soft little mirena causes poking abdominal pains or that their partner can feel it (not the strings mind you, the actual T). One thing that I find helps is that I make EVERY patient hold a little sample IUD of their choice in their hand, and encourage them to play with it, bend it, etc...and then prior to insert, I SHOW them the actual sterile IUD so they know it's the same. Seems to help with some of the mental discomfort (but not all). I also downloaded an IUD Myth handout from the WHO IUD site....and it helps dispel things like the famous "one time, my friend told me that a baby was born with an IUD imbedded in its head"

caralee said...

SMT,
She probably wasn't given the handout prior to insertion.

LilSass said...

Man do I HUMP the IUD! I even wear a damn IUD lapel pin, that's how serious I am about the IUD. I hve spent hours and hours dispelling the IUD myths and I'm not even a damn clinician yet. *sigh* These kinda patients make my head explode. And yeah ... I'm not even a clinician yet.

Anonymous said...

did she mean the 'sponge,' not gel?

Anonymous said...

so true - the number of patients I have who 'want it out' 1 week later. Despite that fact that I remind every person bleeding might be erratic for a bit post - they always seem shocked when it occurs and 'want it out'. ergh...

Anonymous said...

Due to my state's *fabulous* MA system, my clinic barely breaks even when placing Paragards and lost so much money with Mirenas that we can't place them any more. I am an EXTREMELY unhappy camper when a woman insists it is "poking my ovary" and wants it out within months after placement and won't consider any other cause of her "ovarian pain". What a waste!!

Anonymous said...

ovary poking mirena....hahaha. I love that comment.

I remember one woman who read the entire family planning booklet over a period of two weeks, came into the office with her spouse, and looked at me with a serious face to tell me they had decided to use the "female condom". hahaha. I could NOT hide my laughter. I described the condom to her, explained what this would be like as her bc method, and she changed her mind. FEMALE CONDOM.....hilarious. I also had a woman once tell me that her BC of choice was "plan B" I swear to god!

Anonymous said...

I love my IUD. I have Paragaurd, its a copper IUD. I love it so much I was willing to put up with 3 months of pretty heavy spotting and hella heavy periods. Now I can predict my periods almost down to the hour!LOL

Anonymous said...

Hilarious post..and yet, completely true. Why..why, an IUD is a great option..but one should be required to have it in for like 3 years..or maybe committ to community service to make up for the cost that they just put on the system or something. I work in community health too and counsel up and down before IUD insertion and there are still the people who want it out right away..argh

Allison said...

As a PhD student in Nursing, I find the attitudes expressed in this post (and in the comments section) disrespectful.

There are any number of unwanted side effects that can occur with the Mirena IUD.

I question whether it is ethical for a FNP to:
a) decide what side effects are or are not tolerable for the patient, or
b) refuse to remove an IUD on the request of the patient.

I am surprised by Anonymous stating that he/she dismissed the patient's "wicked headaches" as a side effect of the IUD. Clearly it was a problem, or else the patient would not put herself through the cost and trouble to have it removed.

Patients may not use 'our' language to describe their discomfort, but they certainly do not deserve to be dismissed or ridiculed.

I would hope that NPs would aspire to be more sensitive to the concerns of the women under their care.

Anonymous Drifter said...

I'm with Allison, I'm astounded by the disrespect shown by those commenting on this post.

(b) said...

I am all for the IUD too. Where can I get a IUD pin?

Anonymous said...

Allison,
I'm curious... are you practicing as an RN or as an advanced practice nurse?

-Katie, RN/ FNP student

tubal reversal said...
This comment has been removed by a blog administrator.
Mad Quilter said...

I'm pretty shocked too at the disrespect shown to this woman. I'm so so glad that you aren't treating me. I've had my mirena in for 2 months now and I didn't have it put in on a whim it was a serious decision. It was incredibly painful to have it inserted and my doctor was wonderful caring and explained why it had been so uncomfortable for me. Now 3 months later I'm considering having it removed as a result of the return of depression. I'm making an appointment with my doctor to discuss a mental health care plan with me and to investigate if the Mirena has somehow contributed to my current depression. My daughter is 6 months old and I don't feel this is post-natal at all as I have a very strong and positive bond with her.

I was doing a little research on the net to read others experiences with Mirena and depression and came across this post. I'm just shaking my head at how awful this post is. How dehumanising and disrespectful. The foul language used just added to the awfulness of it. Thank goodness you live half the world away and I'll never have to be subjected to a post like this about my choices of birth control.