Friday, June 12, 2009

Out of the rut, follow the gut (instinct, that is)

NewFNP has been caught in the hum-drum of sameness at clinic.  Paps, prenatals, diabetics, URIs.  These are the norm of clinical practice, but the routine gets a little drab.  Don't get newFNP wrong - she doesn't want to work in a emergency room, but she does like a little change-up here and there.

She got it.

NewFNP was doing an abdominal exam during a well-adolescent visit.  The kid was fourteen, had no medical history to speak of and had no complaints.  Nonetheless, the instance newFNP palpated his belly, her internal alarm sounded.

This young man was not especially skinny - just average with a smidge of baby fat.  Had he been thin as a rail, newFNP would not have been so startled when she felt his abdominal aorta pulsating very prominently and pulsating a full two finger breadths to the right of the umbilicus.  She attempted to measure the aorta and estimated about a three-plus inch width.  

NewFNP spent a while running this through her mind.  She didn't feel a mass and she could not determine the direction of the pulsation.  The only thing of which she was certain was that this exam did not feel right.  

She got Dr. Dual-Ivy-League-Degrees to consult -- she agreed that it was an unusual exam.  

Maybe this is normal for him, but son-of-a-bitch if it's an aneurysm.  What are the odds at fourteen years old?  Un-frigging-likely.  Nonetheless, newFNP trusted her gut and sent him and his gut for an ultrasound.  She is anxiously awaiting the results.

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