Tuesday, January 20, 2009

A new beginning

Should today not have been a national holiday?  Should we as a nation not rest for one day every four years to honor ourselves and our President?

NewFNP did pause today.  She sat on the floor of the standing room only waiting room with a precocious five-year old African-American patient in her lap, her five-year old scrawny arms draped around newFNP's neck so that she and newFNP were watching the oath of office cheek to cheek.

"Do you know what today is?" newFNP asked this little girl, M as Vice President Biden exited the podium.

"No - what?" M replied.

"Today is a very special day.  We are getting a new president - our first black president," newFNP told her.

"Obama?!?" she exclaimed, wide-eyed, although she pronounced his name Obommer.  "I like Obommer!"

"So do I," newFNP said, giving M a big squeeze.  "So do I."

Monday, January 19, 2009

Make it a double

It is no surprise to newFNP that STDs are on the rise.  Hell - in newFNP's clinic alone, she had several cases this week!  Gonorrhea, check.  Chlamydia, check.  And repeat.

NewFNP's approach to disclosure of STDs is straightforward.  It is generally something along the lines of: newFNP called you in today because your test results came back positive for chlamydia.  NewFNP then pauses so as to gauge the individual patient's response.  Some people are very nonchalant when they hear the news as though it was only a matter of time.  Some people are angry.  Still others are shocked.

Then there are responses such as this: But she told me that she was a virgin.

Well, maybe she wasn't.  Maybe you were infected asymptomatically and here we are finding out right now.  NewFNP doesn't spend a hell of a lot of time conducting an epidemiological survey.  She treats her patient and, for chlamydia, she dispenses treatment to take to the patient's partner(s).

NewFNP brought her patient some water, his Azithromycin, as well as his partner's treatment dose.  He took his medicine, set down the cup and tapped the partner's bottle.  

"Uh, can I get two of these?" he asked sheepishly.  

Sure buddy.  Two partner treatment doses it is.  Trying to blame it on the ex-virgin.  Indeed!

Thursday, January 08, 2009

Oh-ooh say IUD!

It has been a long time since newFNP donned her protective gown and suited up for the old IUD insertion.  So when her awesome MA told her that her G2P2 with 2 c-sections was in for a placement, newFNP was a little nervous.  A nullip cervix after all these months of an IUD insertion-free existence?  

"Not to worry, newFNP," her MA said," she's menstruating."  And it's day two and it is a-flowin!

So newFNP got her patient prepped in the all-revered lithotomy position, placed the speculum, swabbed the moderate blood to better visualize her work place, and placed the tenaculum at ten and two o'clock.  Click!  Things were moving along super smoothly as newFNP quite easily sounded her patient's uterus to a respectable 9cm.  

As newFNP was adjusting her vadge light to confirm that 9cm was in fact the magic number, a very, very unfortunate event occurred.

During the light adjustment, newFNP made the rookie mistake of not having one hand on the speculum.  You see, newFNP's clinic does not have the fancy light-equipped specula.  It has the old school cumbersome swan-necked style lights.  One hand on the sound, another on the light and a setback occurred.  It was just a seconds-long oversight that led to a size-medium bloody speculum to fly out of this lady's lady business, only to be caught by the still-in-place tenaculum.


NewFNP quickly and blindly removed the uterine sound as her sympathetic nervous system did an auto-reboot.  She then paused for a millisecond to control her blood pressure as her patient and MA laughed the experience off.  Thank God newFNP had done this patient's entire prenatal care course as well as her post-partum and well-baby care, and was known to her patient as not being a total frigging schmuck of a provider.

NewFNP replaced the speculum with the tenaculum still in place, a feat not so easily accomplished - you'll just have to trust newFNP on this one.  She then pulled her other MA into the room for another hand to assist with speculum position maintenance throughout the remainder of the procedure which was as seamless as could be.

Perhaps newFNP should dig up her old chemistry goggles for her future IUD placements.  

Tuesday, January 06, 2009

Thirty five

NewFNP asked for it.  

She wanted to go part time to save her sanity and now her clinic days are jam packed.  Her days are busier than they ever were before.  It is nuts.  But newFNP is pretty cool with it.  

She's even cool with her depressed patients who can present a true challenge during busy clinic days.  

NewFNP must confess that it makes her a little frustrated and causes her to climb on her soapbox when she sees obvious somatic complaints and notes of 'depressed affect' time and time again in patients' charts yet no one steps up to the plate to frigging ask about it.  

Sure, it may feel as though there is not a lot that one person in a busy health clinic which lacks mental health staffing may do to help that patient.  And sometimes it's absolutely true that providers are just too stressed themselves to take on a depression visit.  But we can't be so stressed that we shelf it to the next visit every time.  That is just shrugging off the job and leaving sad, often ineffective and desperate patients in the same hole.  And it is not true that we can do nothing.  True, newFNP is no counselor, but the act of listening is powerful and making it okay for someone to cry, to disclose a crushingly painful secret, to release some bottled up hurt is therapeutic indeed.

NewFNP has been doing a lot of thinking about what kind of provider she is and what kind she wants to be since she has decreased her clinical hours to part time.  It is so obvious that a smile and handshake is a warm way to start a clinic visit, but newFNP can't honestly say that she was providing that regularly in her darkest hours of full-time employment.  She cringed as she read the NYT health blog and saw her bad behaviors in black and white.  Ouch.  She regained that warmth with her switch to part-time.  

And while she is pretty crappy at orthopedic issues, newFNP is damn good at assessing for depression and she does not want to be the provider who ignores it.  In fact, newFNP has found a new sense of purpose and satisfaction in seeing her depressed patients improve.  The change can be so dramatic - what a joy to see that in someone.  NewFNP has diabetic patients, on the other hand, whose A1Cs have hardly improved since being in her care.  That is not so joyous.

Thirty-five patients today.  And yet, newFNP is happy.