Bust a capful

It is not so often that newFNP has one of those "I've never heard that before" moments.  And perhaps a vaginal exam is not the preferable circumstance in which to experience said moment.

NewFNP's patient was gravely concerned that her purportedly well endowed partner had somehow maneuvered her IUD out of position and that she was, therefore, pregnant.  NewFNP had already seen the negative pregnancy test in the chart, delivered the result to the patient and offered to do a quick check to reassure her patient that the IUD was, in fact, intrauterine in location.  

Although she consented to the exam, newFNP's patient specifically requested the use of a small speculum, which seems rather ironic given the reason for her aforementioned concern.

"A small speculum?" questioned newFNP.

"Yes," she replied, "because I use a capful."  The way in which she casually said this assumed that newFNP was in the know regarding the significance of a capful, as though the use of a capful was a secret shared amongst women across the land.

"A capful?" newFNP inquired.

"Yeah, you know, a capful of vinegar," she explained.

NewFNP puzzled expression must have clued her patient in that she was not at all following.

"To keep it tight," she explained, "I put a capful of vinegar in my bathwater and that keeps you tight."

Does it now?

Vinegar.  To dye easter eggs?  Yes.  To clean one's linoleum?  Sure.  To freshen one's coffee pot after a year of French Roast brewing?  OK.  But to keep a vagina tight?  NewFNP is quite sure that Heloise would not offer that as a hint for non-food-based vinegar use.

NewFNP recommended Kegels, confirmed the IUD placement, reassured her patient of both her non-pregnant and actively contracepting status, and went on her vinegar free way.  

Sticks and Stones

NewFNP's clinic is breaking an unspoken mid-to-late December rule: keep it slow.  Get out to the dollar store for some inexpensive winter-wear or to the champurrado vendor for some must-be-an-acquired-taste thick, greasy, masa-based hot chocolate but let newFNP have some holiday peace.  

But no!  NewFNP's productivity is through the frigging roof!  She is averaging 30 patients per day and she has a student to boot.

A sub-par student.

There are some students who are great, like her NP student who attends newFNP's alma mater, like her PA student who was a former army medic and saved newFNP's ass as she incised and drained the biggest ass abscess she has ever seen.  

Her current student is not good.  She's not good.  And she called newFNP "sweetie."  Not once, but twice in the few weeks she has been there.  NewFNP hates that kind of shit.  She's no sweetie, mother-effers.  And she is not B.F.F. with this young woman.  However, newFNP has been so damned busy that she hasn't had the opportunity to nip that shit in the bud.  

Sweetie?!?!!  Ugh.  It's repulsive.

12/21/08 update: In her defense, newFNP's student definitely does not think that she knows everything and she writes everything down.  But her history taking and her SOAP notes are not so good and newFNP is a stickler for a good history and note - it makes everyone's life easier as patients come back for subsequent care.  And then there is the issue of the 'sweetie' thing - is she taking her rotation seriously or is she looking to ingratiate herself?  In newFNP's eyes, the easiest way to a fond feeling is a great performance.  

Violence

NewFNP regularly screens her patients for intimate partner violence (IPV).  It's just one question, usually either "Do you feel safe at home?" or the not so nuanced "Does your partner abuse you?"  It is a hard question to ask, but it becomes less hard the more you ask it and more hard when the answer is yes.

When the answer is yes and you work in a super ridiculous community health center, your day will be sub-par but likely nowhere near as crappy a day as the days leading up to a patient's disclosure that the are abused by their partner.

NewFNP's responses have been varied - she has sat with a patient while the patient called a local hotline, she has referred a patient to our fledgling medical-legal partnership, she has called the police.  

But yesterday, a patient for whom the answer has been 'no' came in and disclosed that, all this time, the answer has in fact been 'yes.'  At some point, this woman had the wherewithal to obtain a restraining order.  This may have been when the abuse extended beyond her and to her oldest child.  

Like many women, she wanted her partner to change.  She wanted the abuse to stop, but she didn't necessarily want the entire relationship to stop.  Like many women, she was afraid of losing her children - a fear heightened by her partner telling her that this was, in fact, what would happen and by her complete detachment from the legal system.  

In some ways, this was an easy decision.  Children are at risk, he violated a restraining order.  NewFNP dialed the police.  Unfortunately, he had left the house by the time they arrived.  

When newFNP was in public health school, she visited a women's prison as a part of a class on family and sexual violence.  It was a life-changing experience.  In that group of women - convicted murderers - there were PTA moms and biker ladies.  There was a woman who killed the man who got her daughter strung out on drugs and abused her.  There was the woman who, after a brutal beating, killed her husband while he slept because he had been threatening to kill her and she knew that he wasn't kidding.  Mostly these women were serving life sentences. 

There are more aspects to this crime - on the batterer's side and the abused partner's side - than newFNP knows.  Issues of power, of fear, of control, of rage, of money and poverty, of fucked up childhoods, of desperation, of gender inequality, of protecting what is valuable to you.  

But these women shouldn't be locked away for life and newFNP's patient should never be in a position so desperate that homicide seems the only solution.

So ask.  Just ask.  As a provider, you might not have all the answers, but you are sure as hell equipped to find them out for a patient who might be caught between the bat and the belt.  Or the gun.  

This little piggy stayed the hell home!

It's getting to be the holiday season and newFNP is sure that, like herself, there are many ladies who would like to get spiffed up for the festivities.

In order to be spiff and shiny, newFNP ordered herself some Kama Ayurveda Miraculous Beauty Fluid (an ayurvedic treasure) and some Lippman Collection Bitches Brew nail lacquer.   Highlights aside, newFNP is a practitioner of DIY beauty.  And though newFNP is loyal to her Retin-A for its utilitarian anti-aging/anti-acne benefits, she is a big lover of the rich, luscious facial serum.

You see, newFNP wants to look pretty pretty, but she does not want to spend tons of dough on comedone extractions and she does not want to go to the nail salon.  And why?  For one, in the world of beauty treatments, isn't a mani-pedi a bit of a rip off?  Especially a manicure - if you are washing your hands all damned day, that $20 mani is shot to hell by patient number 7.  For two, newFNP is super ticklish.  For others, a pedicure is an exercise in relaxation.  For newFNP, it's something that the CIA used to ban.  

But even more importantly, newFNP is simply fearful of having toenail fungus.  When she is 70 years old and her eyes are so bad that she can no longer see her long lady toes, fine.  Toenail fungus it is.  But newFNP is not giving up just yet.

NewFNP sees a lot of funky feet at work.  She overcame her hesitation of peering for areas of maceration between moist toes, freed of their sweaty poly-blend socks and work shoes.  She regularly assesses the dorsalis pedis pulses and is only mildly skeeved by the moist warmth of foot flesh.  

And everyone has onychomycosis.  The odds of finding a full set of normal toenails is somewhere in the ballpark of the odds of winning the Powerball.

Furthermore, newFNP remains scarred by her experience as a young public health professional when an epidemic of cutaneous tuberculosis was traced to a local nail salon and their recirculated water bowls.  Not good.  Not pretty.  Not healthy.  

So for this holiday season, newFNP recommends stocking up on your own favorite beauty treatment and some DIY nail care supplies - scented oil, hot water, a basin, some orange sticks, cuticle trimmers if you're into that sort of thing, a nail buff and nail lacquer.  

Keep those little piggies fungus and TB free!