Tuesday, December 22, 2009

Happy Holidays 2009

Oh my God, does newFNP ever love the holidays. Know why?

A) Time off.

B) Go shorty, it's newFNP's birthday! Not today, but ’tis the M-F-ing season. For her birthday, newFNP bought herself a cashmere sweater on sale. And an Audi. (Hey, it's diesel and newFNP loves herself some leather seats and dual moonroof.) And she even got a cake and a song at clinic today!

But you know what can put a damper on newFNP's holiday/birthday cheer? A $24,000 medical bill from her grandmother's 24-hour hospitalization. Bear in mind, this does not include one cent of physician services. Those are still to come. Of course, newFNP's sweetheart of a grandma won't have to pay this size XXL bill thanks to Medicare. The Medicare discount is a cool $22,000.

Guess what an EKG ran? $494!! NewFNP did 10 EKGs today and she's pretty sure that her clinic won't be billing any insurance $494 per test performed for the frigging things!

So again, why are we not supporting a public option in healthcare reform? Is there a reason that anyone should receive a $24000+ bill for 24 hours of care? Who in the hell can pay for that?

And if there is someone, is he married?


If there was ever a time newFNP wanted a hospital to do its job, it's now. NewFNP is thinking nothing but positive thoughts for Pudge and mature lungs and closed cervices. BostonFNP, keep safe. Love you.

Saturday, December 05, 2009

Always have and always will

NewFNP has the raddest grandparents -- all of them.

When her paternal grandfather died while newFNP was in nursing school 3000 miles away, newFNP asked her brother to help take care of their grandmother. BroFNP moved in and cared for her for four years. When her care exceeded what could be done at home, newFNP moved her grandma to her urban jungle. She had been faring rather well for a 94-year old lady with dementia until this week. She had cough, she was tachypneic, and she had unilateral lower extremity edema. (But she always has edema because she's got the ole Norvasc and she's in a wheelchair.)

Now, newFNP and broFNP have power of attorney, DNR, advance directives -- the whole nine. But having all that is all well & good until one needs to use them.

NewFNP's grandma was admitted to the hospital and had a thoracentesis which drained 700cc of fluid from her right lung. Her duplex ultrasound showed extensive DVTs in her left thigh.

NewFNP opted not to treat. Anticoagulation is not the move for a 94-year old woman and won't improve her quality of life at all. Plus, just last week, her grandma told newFNP that she was "ready to hang it up." NewFNP knew that deciding against treatment could mean deciding for a pulmonary embolism. That's just kind of the beauty and the bitch of being in health care -- one understands the implications of one's decisions. And, frankly, a massive PE is not a bad way to go.

Her decision weighed heavily on her as she watched her grandma doze off in the hospital bed. As she waited for the ambulance to transport her back home, she crawled into her grandma's hospital bed and sobbed. Her grandma reached her hand out to hold newFNP's hand.

"Honey," she said, eyes closed,"I hope you're not getting sick. It sounds like you're stuffed up."

"Yeah Grandma," newFNP replied, "I'm a little stuffy." All the memories of summers and swim lessons and shopping for ESPRIT and lunches at I. Magnin and how her grandma consoled her the evening that her mom died were playing in newFNP's mind as she laid next to her.

NewFNP remained in bed with her Gram sniffling and soaking the sleeve of her James Perse t-shirt until the ambulance arrived. Every once in a while as newFNP and her Grandma snuggled, her Grandma would reach her hand up to scratch her head and then slip it back into newFNP's and give her a little squeeze.

"I love you so much, honey," her grandma told newFNP. "Always have and always will."

When she was leaving, newFNP gave her grandma a kiss goodbye. She turned to get her purse when her grandma said, "I want another kiss."

You got it, Gram. Whatever you want.

Tuesday, December 01, 2009

Pole Position

NewFNP really enjoys IUD placements. She finds procedures fun - a little break from the assessment of DP pulses and the futile attempts to palpate hepatosplenomegaly in her generally overweight patient population.

Today, newFNP had a gregarious patient present for an IUD insertion. NewFNP asked her patient if a colleague who is learning how to place IUDs could observe the procedure.

"Yeah, sure," she replied. "I mean, I used to be a stripper so it's all good."

NewFNP replied, "Oh wow - what was that like for you?"

Some people might be amazed to learn that newFNP had never met a stripper before! She wanted to ask her all the details. How does one learn to pole dance? Do pasties hurt upon removal? What was it like?? Hell, newFNP doesn't even like to walk around the Korean day spa naked, but the rub-n-scrub is worth the lady nakedness. Dollar bills in g-strings would not be worth it to newFNP.

Her patient told newFNP that, not unlike health care, the location of the practice played a significant role in how well one was treated. In ghetto areas, her patient explained, her treatment was not so good. But in nice areas - "with lots of white guys" - it was a pretty good gig.

NewFNP didn't go into it any further, but she would actually really like to learn what it was like for her patient. What was it like the first time she performed? Did she feel hesitation about considering exotic dancing as a job? Was it worth it? Did she feel exploited? Alas, it seemed inappropriate to ask such questions while seated at the business end of the lithotomy position looking past the pierced clitoral hood to the perfectly centered cervical os.

It was the most seamless insertion of newFNP's career. Her patient was completely comfortable and pain-free, talking to newFNP and laughing the entire time.

It's quite nice to have appointments like that during a generally hum drum clinic day.