Two things

One. NewFNP is fucking stoked not to have a mammogram again until age fifty. Not so nuanced a comment, but personal indeed.

Two. NewFNP was leaving Whole Paycheck with bag full of organic goodies and was listening a gentleman on NPR listing the reasons for opposition to health care reform. One reason was the loss of choice. (He didn't specify, but newFNP assumes that he is talking about choice over health care providers as well as the government having a say in what health care can and cannot be provided.) Oh, the irony! After all, isn't there a huge brouhaha over including the choice to have an abortion in the current health care reform debate??!

That kind of stuff makes newFNP want to tell people to suck it.

Saved yet again

Last week, newFNP had had it. She never wanted to return to clinic again. She had one especially bad encounter with a patient that left both parties feeling upset and involved newFNP telling the patient, "Pregnancy is not a disability - you do not need to quit work yet" in a not-so-nice tone and the patient telling newFNP, "You don't understand -- your job is easy." To which, of course, newFNP had an internal fit of apoplexy. It is a damn good thing that newFNP does not know how to say, "You have got to be fucking kidding me" in Spanish.

That, coupled with a few other institutional issues, prompted newFNP to send her resume out early yesterday morning.

And then, newFNP'll be damned, but wouldn't you know it if a patient reached out and touched newFNP in a way that made her love her job all over again. No - in a way that made her want to stay in her job.

This patient is in her 60's, she is a university retiree from newFNP's public health alma mater, she has Crohn's disease, is a breast cancer survivor, fell and had a major knee surgery two months after her chemo ended and was determined to be unable to care for herself post-operatively in her home as she lived alone. Thus, adult protective services placed her in a hella ghetto senior's community a stone's throw from newFNP's clinic which, in case anyone has been sleeping for the past four years, is in one hell of a shithole area. Prior to this determination, she was living in a peaceful suburb in the foothills of newFNP's city. She hasn't had a mammogram in two years and she is only three years post-mastectomy. She hasn't had GI follow-up in over a year. She feels as though she cannot turn to her children for help.

As she recounted her story to newFNP, newFNP just took a moment to acknowledge the hell this woman had been through and asked her if she wanted to talk to a counselor. She made an expression that spoke of her pain, of her sorrow and of her relief in being offered .

She shook her head slowly, ruminatively. "I could use it," she replied, nodding. "It has been a really hard couple of years."

NewFNP put down her pen after having filled the past medical history form and then some on this woman's encounter form, leaned forward toward her patient and said, "I am going to help you." And she meant it -- she meant it more than she usually does. And she felt the importance of helping this woman more than she has in quite some time.

And she did help her. She got her a mammogram even though mammograms are booked through 2010. She got her a counseling appointment. She overstepped her bounds and gave her a friend's email address in the hopes that this friend had some insider knowledge regarding other communities available. She listened. She cared.

But equally as importantly for newFNP is that this woman helped her. She saved newFNP from utter desperation and frustration with her job.

What a wonderful gift newFNP received today. She is so thankful.

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.  

 

Not so lovely lady lumps

It's been a long time since newFNP has been on the business end of a cytobrush.  A year, in fact.  But today was the day for newFNP to go from provider to patient and shimmy down the table into the stirrups for her annual exam.

When newFNP was in training, it was one of her articulated goals to perform the pap well, with the least amount of discomfort possible.  NewFNP has achieved that goal.  Her patient frequently tell her that they barely felt a thing - it makes newFNP so proud.  

In order to achieve her gingerly executed pap exams, newFNP uses the cervical spatula and mascara wand combo and performs 1/2 - 1 turn of each.  She goes from 12 o'clock to 6 o'clock with the spatula and makes a turn with the brush adequate to touch on most areas of a parous cervix.   If she sees an area of suspected abnormality, she gives that a swipe as well.  Throughout the process, she uses a light touch.

NewFNP's OB/GYN, on the other hand, uses the broom cytobrush, aka the cervical pitchfork, and makes about 75,000 full-force turns with that SOB.  She clearly does not believe in the light touch and her "a little cramping here" warning is an understatement indeed.  But fine.  It last for six seconds and is over.

What is not over is the wait for newFNP's diagnostic mammogram.

NewFNP is certain that whatever is embedded her breast tissue is a fibroadenoma.  She is certain that it is not cancer.  But now she has to have a boob and metal sandwich because the seed of doubt has been planted and her OB/GYN encouraged her to get that frigging thing done without delay.  And she's kind of pissed because of course it will be nothing yet she will have had to have her never-lactated, full-density breast all squished up in order to have the reassurance.

Ouch.

And nothing makes a lady feel old - prematurely old - like having a goddamned mammogram.  

A sweet rack

Dude.

NewFNP is totally cool with mental health days.  Go to the Korean Day Spa for a naked lady Rub-n-Scrub and shed that nasty dead skin!  Go see I Love You, Man and eat a large popcorn.  Sleep.  Whatever.  

But do not be newFNP's MA and call in sick when you are, in fact, getting new boobs.  

Sure, go ahead and get your new knockers.  Whatever.  Your life is hard.  Your soon-to-be-ex-husband is a dick.  NewFNP understand the urge to make a change when a relationship ends.  But take a day and get a frigging facial, a hair-do and some airbrushed Coach nails.  

But when you are having cosmetic surgery, you should take a vacation day (or seven).   You should not be the employee that burdens her colleagues for boobs.   And just how much is newFNP's clinic paying these MA's, for the love of God, if they are taking sick days for rack enhancement?!!

Honestly, newFNP just does not understand the desire for two inflated saline balloons in one's chest.  Just get some boob cutlets and a push-up bra and call it a day.  Total cost - fifty bucks.  Less if you hit up the semi-annual sale at VS.

But even more of a bummer is that newFNP has really felt like this employee was committed to the team and understood the importance of her role.  

And that changed today.  Possibly even as much as her MA's new cup size.

Hold the mayo

There are days during which patients just break newFNP's heart.

Imagine having gone through a fetal loss, an ectopic with subsequent tubal scarring and years of infertility before finally meeting a reproductive endocrinologist who will work with you when you're uninsured. Imagine being evaluated for Clomid and preparing to start using it. Then imagine finding a breast lump. Then having a fine needle biopsy with a "bad" result. And then imagine the waiting between those results and your impending excisional biopsy, when you have nothing to do but think of how you're not pregnant and how maybe you have breast cancer just like the beautiful woman sitting next to you in the breast clinic when you had your needle biopsy.

And on top of all that crap you get a cold and end up in newFNP's care. Son of a bitch, right? That's just what you need!

NewFNP breaks the touch barrier a lot. She believes that a handshake or a simple pat on the back or the arm goes a long way in welcoming patients. NewFNP took this patient into her arms today as she sobbed.

So, yes, there are days when patients just break newFNP's heart. Of course, there are also days during which patients just bust newFNP's chops as well.

Today was a combo platter.

It's nippy out

Ah, fashion. NewFNP loves fashion. NewFNP loves shopping. Just to descend into the warm embrace of the Prada SoHo, to flirt with the sassy Sigerson flats, to luxuriate in the sensation of a Theory cashmere sweater against one's cheek - even at the outlets! NewFNP loves it all.

There are, however, some fashion trends newFNP just can't endorse. These include MC Hammer pants. Can't touch this? Yeah, no shit - who would want to with those baggy ass yellow trousers? Also on the list are jelly shoes, even Marc Jacobs jellies. A current fashion forward look which newFNP finds revolting are the gladiator sandals. Go away with your leather ties up your legs. It's ugly and slutty looking.

A look that has likely not graced the pages of Vogue or Marie Claire in some time might be the half-shirt. As fashion forward newFNP readers know, longer tees are in. Bare midriff - out.

Apparently, our 275-pound walk-in yesterday morning didn't get the memo. She also must have missed the memo that it is important for breast health to wear a bra. She clearly missed the memo stating that one's ample bosom belongs inside one's half shirt as opposed to hanging out of the bottom, nipple pointing directly to the floor.

Is newFNP wrong, or is it very unusual for a woman to bear her nipple in public? Granted, newFNP lives in a rather progressive city where the climate is mild and where boobs are an important accessory. Nonetheless, it is newFNP's opinion that one must be utterly divorced from reality to A) find it acceptable to share one's lady-goods with all of the clinical staff and patients or B) not realize that one's nipple is actually out of one's shirt! I mean, come on, isn't it even a little cold? Isn't there a breeze with which to contend?

Bottom line: newFNP is no conservative, but she votes to keep the nipples in the shirts when in public.