Friday, May 29, 2009

Dress code violation

The inappropriate t-shirt trend has followed newFNP to the research clinic.  The reach of the inappropriate t-shirt is, apparently, far and wide.

When newFNP saw her patient filling out forms in the waiting room, she did note that his shirt said "F.B.I." across the chest.  NewFNP naively thought that this gentleman seeking to participate in a research study about methamphetamine addiction was perhaps showcasing a touch of irony.

Not so much.  Upon closer inspection, newFNP notes that underneath the "F.B.I.", the shirt read "Female Body Inspector."  Classy.  The only female body part newFNP will let this fellow inspect is her stank eye.

But the self-appointed Female Body Inspector had nothing on the wildly inappropriate t-shirt that another research participant was wearing.  This shirt was a walking advertisement for the metal band Cloven Hoof.  This shirt featured a graphic of a mullet-man orally pleasuring a woman.  Charming.  NewFNP gets it - figuratively - and she is none too pleased.  

When newFNP gets dressed in the morning, she does the usual mirror checks: no VPL, no muffin top, no boob overflow, no totally fucking offensive t-shirt.  Check, check, check and most definitely check.

I mean really.  Cloven Hoof?  Cunnilingus?  What makes someone purchase such a shirt?  And then what possesses someone to wear that shirt to a medical clinic?  


Saturday, May 23, 2009


What's up, nurses?  We're fucking famous, that's what.  Or maybe nursing leaders are in cahoots with the entertainment industry to make nursing appear to be a more attractive profession in the face of a horrible nursing shortage.

Not one, but two new TV shows with nurses as lead characters!!  Showtime's Nurse Jackie and TNT's HawthoRNe.  

NewFNP's hope is that the TV shows will do nursing justice and that the characters will be interesting and complex and funny and smart.  It's newFNP's fear that a recurring dynamic is going to be the physician-nurse tension as is showcased in the HawthoRNe commercial.  That dynamic is tired.

NewFNP's money is on 'Nurse Jackie'.  It has Edie Falco, it's on cable and on the same network that brought us 'Weeds' and 'Huff', it has a nursing student character and it appears to have been thoughtful in its character development.  

And if the show's writers need any technical assistance with the science and art of nursing or with story line development, newFNP shall avail herself to them!

Wednesday, May 13, 2009

You down with PCP (yeah, you know me)

It cannot be stressed enough - the 30th patient of the day must not - repeat not - be difficult. That patient could be clinically complicated but personally reasonable or that patient could have a "gimme" diagnosis. NewFNP's favorite is UTI, but she could go for an otitis media or a fungal derm as well.

NewFNP isn't sure how to triage for this when scheduling appointments, but if she could develop an algorithm for optimal patient scheduling that ruled out end of day challenges, she could retire and buy an S4 and some Tory Burch tunics.

As newFNP perused patient #30's chart before entering the room at 4:40 to begin said patient's complete physical, she noted that another provider had charted "PCP abuse."

PCP? NewFNP glanced at her watch. She had not, in fact, used her flux capacitor and time travelled back to 1983. It was firmly 2009. She imagined that the demand for PCP would be minimal and that this patient's dealer might have a 2-for-1 special or a sign that screamed, "PCP - no waiting!!" whereas the lines for meth and crack would loop around the block. Of course, truly, newFNP has no frigging idea about PCP procurement. And even more significantly, she has no idea about PCP addiction treatment.

So newFNP goes about the social and medical histories which, as one might imagine, were both colorful and sad, and got around to asking about the PCP. She had been smoking PCP on and off for over 20 years.

"When was the last time you used PCP?" newFNP asked?

"Well, it stays in your system for a long time," #30 replied.

Hmmmm. It's an answer, yes, but it's an answer to an entirely different question.

"Oh, OK," newFNP responded. "So about how long ago was the last time you used PCP?"

"I want to stop," #30 replied. "It's hard to be a mom."

NewFNP imagines that it is hard to be a mom and that anyone would want to stop PCP use. Still, that nagging little question was stuck in newFNP's craw. NewFNP acknowledged her patient's desire to stop and assured her that she would receive a referral to behavioral health/addiction medicine treatment. But she had to ask.

"I'm sorry but I'm still unclear as to the last time you used PCP," newFNP gently prodded.

"I told you already!" #30 exclaimed.

"I don't think you did," newFNP stated. "You told me that you wanted to stop and that PCP stays in your system for quite some time. But I don't know how long ago you used."

"A month ago," she stated, as easy as 1-2-3.

The thing about PCP is that its lore is full of horror stories - people thinking they can fly while intoxicated, people exhibiting superhuman strength, people having delusions and behaving violently. And it's an hallucinogen, a class of drugs for which there is a paucity of documented treatment modalities.

So, after a month of not using in the face of all the same life stressors as are always there, how does someone maintain abstinence?

NewFNP gave her a counseling referral and some encouragement, but that's not really enough. Unfortunately, it's all many primary care providers have to give. Mental health and addiction treatments are expensive and not adequately covered under insurance plans and certainly not under this woman's public insurance plan.

Maybe newFNP should refer people to Intervention - let Jeff or Candy give it a whirl.

Monday, May 04, 2009

Rack 'em up

NewFNP is back from her conference and - you know - nothing says 'welcome home' like a diagnostic mammogram!  As she prepared for her appointment and dutifully neglected to deoderize and moisturize, she reminded herself not to worry until there was something to worry about.  She arrived at her fancy-pants medical center, registered, donned the wristband and was called back to get changed.

She changed into her seersucker gown in the mammography center dressing room and glanced at herself in the full-length on her way out.  The mammo-gown was actually flattering.  They must have had DVF design the fucking thing.

Having never had a screening mammogram, newFNP is not quite certain as to the extent of its torture but she will say this: the diagnostic mammo is no way to get initiated into the world of breast imaging.  Eight views - none pleasant.  

NewFNP didn't realize that, in addition to the breast tissue, the mammography technician would need to manipulate her xiphoid process into the images.  

When her sweet as could be technician finally got newFNP's breast flattened so as to resemble a fucking crepe, she - in all seriousness - told newFNP not to move.

"Honey, I wouldn't dream of it," newFNP responded.  After all, newFNP rather likes having two generally symmetrical breasts and felt quite certain that any attempt at escape would be a) futile and b) mutilating.  

Although newFNP made light of her situation with her technician, she couldn't help but to feel a twinge of worry.  Her face must have betrayed her worry and a kind lady in the waiting room commented on what a horrible waiting room we were in. 

NewFNP agreed.  The woman told her that she had her first mammography at 37 and that her mother had died at a young age from breast cancer.  She went on to say that she had had "a thing" removed a few years ago.  It was benign.

"I have a thing," newFNP told her.  Although newFNP knows it is benign, it felt oddly good to unburden herself to this lovely and kind stranger.

"You do not worry until there is something to worry about," the woman told newFNP, echoing her very own thought.  "That is not denial," she said as we stood together to schedule our next appointments - hers in one year, newFNP's in two days for ultrasound.

(NewFNP made the follow-up appointment, but could not help but to think that she is caught in the middle of a CYA-medicine spiral.  Is the fine needle biopsy next?)

NewFNP and this woman finished their boob and metal sandwiches at the same time and walked down to the valet together.  As the valet drove her car around, newFNP commented that we have the exact same car.

"It was meant to be," she said and gave newFNP a caring smile that made her believe it was true.  

Saturday, May 02, 2009

Taking it (the Big) Easy

The last time newFNP was in New Orleans, she was 22, on a meandering cross country road trip which had such highlights as the Carlsbad Caverns, Graceland and a variety of Shoney's restaurants, and was bunking in a bright pink hotel called The Frenchmen.  

This time she is at a conference - an addiction medicine conference - at the Hilton.  

Note to the addiction medicine conference organizers: there is a W just a block away.  Think about it.

Anyway, the highlight of the conference so far may be the following patient quote shared with the audience of listeners at a lecture about stimulant use and hypersexual behavior.  The patient, noting his inextricable link between buckwild sex and cocaine use lamented, "I guess I'll just have to get used to sex without the hookers and the drugs." 

The quote is funny, but newFNP acknowledges that is problem is, of course, not.

NewFNP did make a quick afternoon escape from addiction to see a super great/creepy exhibit at the Audubon Insectarium and to sample some local cuisine: she had fried alligator (and a salad) for lunch.