Yippy-kay-yay!

NewFNP's mom died twenty-two years ago today so after a busy day at clinic, newFNP was feeling a little gloomy on the quiet ride home.

Then she saw a gentleman riding a horse down the sidewalk along a very busy thoroughfare in her very urban city and broke into laughter. He was heading west, then turned to head north down another busy street. Adios, partner.

Who wouldn't feel better?

Potty mouth

NewFNP had a completely fucking bizarro day at clinic today.

For starters, her first two patients -- both new to clinic, of course -- had schizophrenia. The second one also had a wonky eye.

Then there was the chlamydia patient -- the first chlamydia of the day. The first patient was pretty normal. However, he had genital warts that were growing in perfect projectile symmetry on either side of the glans, conjuring images of a caterpillar. NewFNP is a sucker for symmetry and, in fact, has a real aesthetic bias against asymmetry and has, frankly, never seen warts grow in such mirror images of each other in non-touching skin.

Then she had a syphilis patient and began to wonder if she had stumbled into the mental health/STD clinic.

Then she saw what felt like another 7 million patients when she came across her second chlamydia patient of the day: a 17-year old primigravida who is 38 weeks and 4 days pregnant and who had her first prenatal visit last week. Can newFNP interest you in Azithromycin?? Open wide.

Then she saw five other patients when her clinic manager and the brand new RN came in at 5:15 and asked if she would please see another patient, to which newFNP replied, "You have got to be fucking kidding me." And then she saw two more patients.

NewFNP's mouth is absolutely going to get her in trouble one day. She needs to reign it in. In her defense, however, newFNP did not have even a 10 minute break today. She peed once and texted a patient her lab results from the bathroom.

What newFNP really needs is to work in a high-functioning community health clinic with the gestalt of a tattoo shop. Barring that, though, she really should learn to just shut the eff up.

S-A-TUR-D-A-Y! Clinic!

When newFNP was in public health school and was discussing access to health services, she recalls evening hours and weekend hours being touted as one option the system provides in order to increase access to care. All these years later, it is exactly those two things that newFNP likes the least about her schedule.

Nonetheless, as she was seeing patients yesterday during a very busy Saturday, she was reminded of a few lessons in patient care.

It is not uncommon that when newFNP asks a patient how they are, they answer "Mal." Bad. Truth be told, it is newFNP's least favorite way to start a visit (although she completely acknowledges that this reaction is completely her own baggage). Can't we just pretty please have a moment of pleasantries before we delve into the nitty-gritty of the visit? Alas, newFNP has found that when people answer in such a way, it generally is because they are doing badly and probably have taxed each and every ounce of their resiliency reserves to the point of complete bankruptcy such that they can't even fake it anymore. It is always a tip off to newFNP that she must screen for depression.

It is also not uncommon that as patients are waiting to be seen at newFNP's clinic, the waiting room is frequently SRO. It is loud. It gets dirty. The temperature is never just right. It sometimes smells not-so-fresh. The time spent in that room can accumulate into hours. Being a competent and kind provider goes a hell of a long way to ameliorate the effects of that hellish wait. As she was finishing up a prenatal visit yesterday -- one which truthfully felt a little rushed to newFNP -- her patient told newFNP, "Can I see you again? I like the way you take care of me." It made newFNP feel proud and guilty at the same time, feeling good that the patient felt well cared for and feeling mal knowing that this patient didn't really receive the best care newFNP could have offered her.

It is really wonderful to take a moment to reflect upon these lessons. And it is so much sweeter as newFNP reflects upon them while in her dining room, drinking French Roast, Sunday NY Times by her side, decidedly out of weekend clinic responsibilities.

Pop

NewFNP is hard pressed to identify anything that separates her from her patients more than does diet, culturally speaking.

One of newFNP's physical exam preventive health screening questions is: Do you eat fruits and vegetables every day? The answer is generally no. She also asks: Do you drink soda? This answer, in contrast, is generally yes.

But the answer is not so commonly yes to the tune of 60 liters of soda daily. Sixty liters seems, shall we say, excessive. That level of consumption constitutes approximately 2500 calories per day and 100% of them in nutrient-void carbohydrates. In addition, it's doubtful that all remaining calorie source were from broccoli and artichokes.

Her patient very earnestly told newFNP that she was uncomfortable with her weight and wanted to change her diet in order to drop some ell-bee's. Nutritional counseling was not so much of a challenge.

But newFNP wondered what happened to the off switch in someone who consumes that amount of soda. It might meet the DSM-V criteria for soda addiction. It is affecting her health, she continues to use soda despite suffering as a result, she has tried to stop but hasn't been able to yet. NewFNP didn't recommend any specific diet, but she did recommend complete cessation of soda consumption in addition to initiation of physical activity.

Can we incorporate infant and childhood nutrition into prenatal classes? Because this kind of whack diet needs to stop way the hell before it starts!

Undecided

Oh my God, does newFNP ever need to get her shit together.

For one, she misses clinic. She loves working at the research clinic because she has awesome colleagues. But she loves working at the community health clinic because she loves the work. (And has a handful of awesome colleagues in the midst of the wackiness.)

For two, how do ladies figure out A) if they want to have kids and B) when the hell to interrupt their very busy lives in order to do so? NewFNP is on the fence and she is also AMA. On the one hand, she sees an iPhone pic of BostonFNP holding her newborn and looking happier than quite literally ever before. On the other, she sees a thirty-something year old woman with an eviscerated perineum after a perineal wound repair dehiscence. NewFNP has a longstanding history of not inviting chaos into her personal life, yet completely acknowledges that kids are kind of a cool chaos. If only newFNP could be a dad...

For three, why in the world did newFNP consent to getting her cholesterol checked the Monday following the Christmas/birthday holiday weekend? How could newFNP, who practically survives on veggies, fruits, Omega-3 supplements and grains, have somewhat elevated triglycerides?? She'll tell you - a weekend full of shrimp dip, bagels and lox, mashed potatoes and birthday cake. NewFNP makes it a practice to completely invert her food pyramid December 24-26 and now look where that practice has landed her. Mother fuck. NewFNP hates not getting 100% on her FLP.

So it looks like newFNP has some shit to figure out this year.

Whatever... bring it.