Wednesday, March 28, 2007

A personal tale

It should be no news to newFNP readers that newFNP's schedule is busy, overbooked, conducted in Spanish and often overwhelming. Given that, little personal difficulties may cause newFNP to experience her work stress on a continuum ranging from extra-stressful to unbearable.

Some examples.

A lone pimple: extra-stressful.
Bad hair day: pretty much every day, thus no added stress. Thank goodness for My Little Pony-tails.
Forgotten Nalgene: dehydratingly stressful.
Fight with Punjabi boyfriend: extra-stressful, that gaddha.

So imagine what real personal trauma might do.

NewFNP was raised by her maternal aunt from the age of 14, when her mother died suddenly after suffering a cerebral aneurysm. NewFNP's aunt, like her mom, was a single mom with two children. NewFNP's cousins are like her brothers. They snowboarded with newFNP, they white-water kayaked and rock-climbed together.

Two months before newFNP finished her studies, her older cousin was diagnosed with glioblastoma multiforme. She spent the summer after finishing her MSN with him, driving him to radiation every day, watching The West Wing on DVD and eating take-out Mexican and Baskin-Robbins. Last week, he started hospice care. He's 35. Thirty-fucking-five.

NewFNP spent last weekend holding his hand as he walked down the hall, paralyzed on his left, unable to walk alone. She held the container for him to urinate into. She sat by the hospital bed now in his bedroom while he slept. These intimacies that nurses share... well, newFNP has never shared them with another family member. While his mom does this for him on a daily basis, the last time newFNP spent time with him, he was walking alone. He wasn't asking newFNP about his impending death. He wasn't asking about what would happen when he could no longer walk or swallow.

NewFNP has a sweet patient now who had the tip of his finger traumatically amputated by a soccer cleat last weekend. He comes in for dressing changes and evaluation. It's a quiet appointment: cleaning, wrapping, assessing for re-growth of tissue that resembles a finger.

On Monday, newFNP could see him mourning the loss of his normal finger. Cleaning, thinking, Bacitracin-ing, fighting back tears, wrapping, mourning.

The odd thing is, in the midst of experiencing sadness of such depth that she cannot imagine it's resolution, newFNP has been surprisingly peaceful at work. It's not that she doesn't care. It's just - well - newFNP doesn't really know what it is.

She just can't leave the profound sadness at the door.

Wednesday, March 21, 2007

The real Dr. McDreamy*

NewFNP's clinic is going through a real change.

As of Monday, newFNP's supervising physician is gone. Over the past 18 months, this woman has been there for newFNP to educate, to support, to encourage and, at times, to commiserate. She is so good with patients that she could be an NP! And she was a huge advocate for the providers.

NewFNP has felt her loss frequently these past three days, perhaps most often when she was seeing Dr. Awesome's patients whose appointments the receptionists had neglected or otherwise failed to cancel. One example of this was when newFNP saw three scheduled 8:30 appointments today - 2 of Dr. Awesome's & 1 of her own. Another example was when she saw a physical scheduled for 3:30PM at 5:10PM. Did newFNP mention that this patient has fibromyalgia? Well, she does. 5:10PM - starting time.

Has newFNP mentioned recently that her clinic closes at 5PM?

Scheduling consequences aside, the most horrible thing about losing Dr. Awesome is that a great ally, a terrific leader, an inspirational provider and a physician who doesn't crawl up her newFNP's ass is gone.

And why is she gone? NewFNP thinks that her chronicle of the past year and one-half suffices for an explanation.

*newFNP has never seen Grey's Anatomy, nor does she endorse super-skinny girls with big pouts or homophobia.

Wednesday, March 14, 2007

Thar she blows

NewFNP loves derm. Paring down and freezing off warts - love it. Pityriasis - fascinating. Acne - please let newFNP help. And don't get newFNP started on Retin-A. It is her second favorite medicine after the Pill. In fact, scratch that. As newFNP is in her thirties, Retin-A is usurping the Pill's position as #1 medicine of newFNP's life.

Yes, newFNP loves derm. In fact, prior to getting master's degree #1, newFNP toyed with the idea of going to beauty school to be an aesthetician. What a cushy job. Soft music, aromatherapy candles, Sothys or Peter Thomas Roth product as far as the eye can see, comedone extractions.... ahhhhh. Well, newFNP didn't even have the chance to be a beauty school dropout. No, she pursued a career allowing her to benefit humanity in a different way. Who knows, however, what the future holds with the rise of the medi-spa.

In newFNP's clinic, she does not have a lot of opportunity to practice derm. Sure there are plenty of abscesses, but one cannot deny the olfactory component of the I&D which detracts from newFNP's overall satisfaction with the experience.

Enter the epidermoid cyst.

It's like Christmas and Hanukkah all rolled up into one for newFNP. Gross as it may be, there is something very gratifying about expressing 80,000 pounds (give or take) of sebaceous material from a huge cyst. It helps to have lifted some weights prior to the expression of said contents because one truly does need to apply a good deal of pressure. And newFNP would encourage all epidermoid cyst excisers to get the sac wall out, for the love of all that is holy. Sure it would be fun to go through the process all over again, but the patient may feel some dissatisfaction.

For a great article about protecting oneself and staff from the potential spraying contents and for an overall "how to," check out: Very helpful.

Tuesday, March 13, 2007

It doesn't take long

The first few days of work after returning from a two-week vacation, newFNP had a sort of Teflon Don-like armor, protecting her from all of the bull crap that had been bogging her down prior to her departure. NewFNP was so well-rested after her vay-cay, she felt like she had received a bull crap vaccine. She smiled, she enjoyed her patients and her relaxed demeanor was remarked upon by many patients and staff, including the C.O.O. In fact, more than one person asked newFNP if she had lost weight! NewFNP must have looked good!

Then, on her 3rd day back in clinic, newFNP began to notice that labels were missing from charts, that blood pressures weren't being recorded, and that her schedule was overbooked. Her M.A. lied to her face at 5:20 PM. The bull crap vaccine must not confer 100% immunity! GSK and Merck, where are you when newFNP is in need?

NewFNP didn't appreciate that there was a ratio at play here: for every one week of vacation, one may expect one day of immunity from the bologna regularly experienced in community health. After that, the protective effect wanes, and how!

And nothing will make that armor disappear like another provider going on vacation and the front office staff both neglecting to cancel her many appointments and allowing many of her patients to be seen despite newFNP having a full schedule herself. Yes, a 34-patient day pretty much wipes out any glow newFNP may have returned with. During her morning commute, newFNP is again fantasizing about quitting.

She is at the 50% mark of her service commitment.

Fucking hell. Another 18 months to go.

Tuesday, March 06, 2007

NewFNP felt like a rock star today, returning to the clinic. The floors were waxed, the staff gave newFNP hugs. NewFNP had to wonder if she found her way into the wrong clinic!

Ah, but then newFNP saw that the C.O.O. had scheduled her to work two six-day workweeks and she knew that she was, in fact, in the right clinic after all. That fucker.

And - just like that - newFNP was back at it.

After a year and a half in practice, newFNP finds that she is less and less frequently surprised by her clinical encounters. Today, however, was an exception.

It is no surprise that a woman who has had one lifetime pap twelve years ago would feel apprehensive about assuming the position. It is also no surprise that said woman would adopt that "straight leg, buns firmly planted halfway up the exam table" position when readying herself for the pap. In newFNP's practice, it is a little surprising to see a 32-year old woman with only one child (although actively trying for more since her first birth), but not so surprising as to merit a second thought during the patient's first visit on a busy clinical day.

What is surprising is to get the speculum placed and see an IUD string protruding from the os when the patient is quite clear that her birth control method is "condoms sometimes." When newFNP questioned her patient about the IUD, the patient stated that she had received the IUD after the birth of her 12-year old son, but was told that she had expelled it when she went for her one-month check up after insertion. Surprise! The 12-year old IUD is still contracepting! Well, it was until newFNP yanked that MF-er out.

What is even more surprising about this encounter is that less than 24 hours prior to experiencing it, newFNP received an e-mail from a friend from graduate school stating that she had the exact same experience. WTF! NewFNP knew that clinic encounters came in waves, but she didn't know that these waves cross county lines! What a phenomenon!

Monday, March 05, 2007

Flying high

If newFNP can share only one pearl of wisdom with her readers, let it be this: Coach to India is not the way to fly. NewFNP highly recommends the exit row for those who work in community health and cannot charge business class to their already balance-ridden credit card.

Aside from that, newFNP recommends India wholeheartedly. And acidophillus - take acidophillus while vacationing. And bring TP to all public loos.

Back to the clinic tomorrow morning.