Friday, January 26, 2007

newFNP couldn't agree more

In general, newFNP's clinic reserves Fridays for pediatric well-visits and follow-ups. However, as we are not complete a-holes, we do let an occasional adult in for pressing health issues.

NewFNP was treating a lovely 34-year old woman today for a UTI when she said, "You should be a model, not a doctor." True, so true - doctor/nurse practitioner distinction aside, of course.

Who looks pregnant now, motherfuckers?

Wednesday, January 24, 2007

When it's good to be newFNP

As newFNP's readers know, newFNP has her good newFNP days and her bad newFNP days.

NewFNP was so thankful today to spend 10 minutes educating the mom of a 12-month old about why we are changing him from QID Albuterol to BID Pulmicort Respules and prn Albuterol. NewFNP really felt like she empowered this mom to control her kid's asthma and got some buy-in about just how crucial this is. The mom was grateful and newFNP was invigorated.

NewFNP felt like it was one of the best FNP encounters she has had in such a long time.

Or maybe newFNP ate scrambled some Valium in her egg whites this morning and this lovely encounter (one of twenty-something) was all a glorious dream.

Friday, January 19, 2007

Don't be a fool - stay in school!

NewFNP loves school. She wishes that she could forever just go to school. The life of a student - a grad student that is - is one which suits newFNP to a T. Some classes, some studying/snacking/coffee at a local coffee house with her pals, some hitting the awesome 7-story gym provided to her by her educational institution, some thinking, contemplating, practicing, reading... you get the picture.

Now newFNP knows that high, middle and primary schools are not as much fun as grad school, yet they are probably more important because they are a platform, a springboard if you will, to bigger and better things.

Thus, newFNP's newest pet peeve: parents who are not teaching their kids to value school. It's always been an issue for newFNP, but this past week has been the worst. Take you kid to school, take their fucking TV out of their room if their grades are in the pooper and don't pull them out of school for 2 months to go visit relatives in another country. NewFNP just read an article in The New Yorker about parents pulling their kids out of an urban high school in Denver in order to take them to dry wall jobs. To newFNP, that is unconscionable.

Lest anyone think that newFNP was a child of privilege, let newFNP assure you that that is not the case. NewFNP's family simply taught newFNP's generation that we would be successful in education and life. The strategy worked.

NewFNP is not insensitive to the fact that people need to pay the rent. But here, in newFNP's frigging expensive city, if you don't want to live paycheck to paycheck, you had better get an education and a good job.

So go to frigging school!

Wednesday, January 10, 2007

And away you go!

NewFNP has noticed that it is, in fact, getting easier to know when to send patients to the ED. NewFNP has harbored a fear of over-reacting and sending patients to the ED when they are merely suffering from gas or a plateful of questionable seafood.

It's a fault of newFNP's training program, frankly - not enough experience with emergent patients.

Anywho, newFNP send yet another patient to the ED today. This lady weighed 350 pounds, had a smoking history of 35 pack years, sat for a multiple-hour car ride six days ago and has had exquisite left calf pain for 4 days. No relief with anything, worse with walking. NewFNP's clinic does not have the diagnostic equipment to rule out the DVT and newFNP's patient was at too high a risk to watch and wait. Was she short of breath? Hell yes she was, but who's to say whether it's from the magical combination of obesity and smoking or not? Her lungs sounded fine, but who can trust an auscultation through 2 inches of adipose? Did newFNP feel a cord, a pulsating mass, an area of increased warmth? She did not. However, this woman's calf had the circumference of a watermelon. NewFNP couldn't feel a thing.

Now, in general, newFNP hates to be wrong. However, newFNP hopes to be wrong about this patient. NewFNP hopes that she has some muscle spasm/arthritis/hypersensitivity - whatever. She just has to be sure. Yesterday, newFNP send a 16-week primip to the ED because she couldn't find a FHT after multiple attempts. Thankfully, the ED saw the heart beating on ultrasound. NewFNP is very thankful that she was wrong and doesn't want any patient to have a bad outcome to prove her right.

Tuesday, January 09, 2007

Vacation all newFNP ever wanted

NewFNP is counting down the days until her 2 week vacation. A little over a month and she will be jetting to a far away and exotic land - a land requiring both passport and visa, a land of monkeys and cows roaming the streets, a land requiring prophylactic Cipro.

But until then, newFNP continues to toil day in and day out. She dutifully educates regarding URI's and asthma. She skillfully performs paps as fast as possible. Just like a bank robbery - get in and get out. She supportively advises diabetic patients to lay off the orange soda, Hot Cheetos and multi-tortilla meals.

And today, she felt her first-ever silicone-injected buns. NewFNP's patient had visited another country for breast implants, rhinoplasty, Jolie lips and gluteal enhancement. If newFNP's readers have never felt silicone injected buns, they feel lumpy and hard. Perhaps newFNP's patient is the exception and perhaps silicone gluteal implants feel nice, but silicone injections do not. They especially do not feel nice when they are harboring a large, erythematous, taut abscess. But abscesses are old news to newFNP readers by now.

What is new to newFNP is the technique of packing the wound using a long q-tip to introduce the wick. For all these months, newFNP had been hoping and praying that her closed tweezers wouldn't accidentally open inside of her patients. Is it wrong to hope that newFNP will get to use her new technique soon?

And here's a little note to any male newFNP readers who might not have a clue. When someone like newFNP walks in the room and you give her a big hug, ask how she's doing and acknowledge that is has in fact been quite a while since you've had an appointment, the next thing out of your mouth should not be "Are you pregnant?" A good rule of thumb is that if there is a head sticking out of a woman's vagina, it's likely that she's pregnant. If it's 10-15 days after Channukah, Christmas, newFNP's birthday and new year's, it's a brilliant idea to cut a sister some slack and let the salads and gym kick in a bit.

Seriously, what the fuck?