Ho no she didn't

NewFNP was driving to work early this morning and it's possible that she didn't entirely have her senses about her. She was driving through an area that is known for being up to no good, but that's pretty routine for her so it was no BFD.

Readers of newFNP know that newFNP considers shopping to be as essential to her life as oxygen, George Clooney and the Sunday Styles. So when she saw a sign for "hoe-tique," she did a double take.

Hoe-tique?! Shitty neighborhood or not, it doesn't seem right that one could just walk in and buy a ho like that! Or maybe they just sell ho accessories such as short-shorts and thigh-high patent pleather boots.

Upon closer inspection, newFNP realized that the store was, in fact, a Shoe-tique but that the "S" had faded over time. Now, newFNP does love herself some new shoes, but she was a little happier when the store was the hoe-tique.

After all, new shoes are a dime a dozen. New hos are harder to come by.

Sunken treasure

There are a few things which, if found in her bathtub, newFNP would wrap in a cloth napkin and tuck away in her lingerie drawer for safe keeping. These include a Harry Winston 3-carat flawless diamond, a bar of gold bouillon and a love letter from George Clooney begging for a second date.

What she would not keep is a year old Mirena IUD that had spontaneously expelled itself from her daughter's uterus.

Granted, newFNP does not have a daughter, let alone a daughter old enough to have an IUD, but she's quite certain that if presented with that scenario, she's not keeping the IUD as some progestin secreting family heirloom.

But this is exactly what happened. NewFNP's patient presented to have a new IUD placed but had no evidence that the IUD string hadn't ascended rather than the whole damn thing falling out. Did she see the IUD or feel the IUD expelling? She did not. Her only proof of expelled IUD was the return of a normal menstrual period after a menses-free year. Sadly, that is not grade A evidence. NewFNP unsuccessfully hunted for strings and then filled out the referral for an ultrasound to confirm expulsion. A uterus is, after all, designed for only one IUD at a time.

Her patient went home and got on the horn to make the ultrasound appointment. Her mom, also a patient of newFNP's, overheard the conversation and, with a sly smile on her face, presented her daughter with a daintily folded cloth napkin. Inside was her Mirena.

Why? Why wait? Why keep the IUD and not let one's daughter know that she is no longer effectively contracepting? Why keep it?

It's all so confounding for newFNP.

And hey -- let's just put that napkin in the trash, shall we? If ever there were a situation that called for cloth napkin wasting, this is it.

Schadenfreude

NewFNP wants to say right off the bat - take that O.J., you murdering, armed robbering, kidnapping motherfucker!  Sure, you got away with murder, you SOB, but you couldn't just walk the straight and narrow and the good people of Las Vegas were wise enough to do what the people of Los Angeles could not thirteen years ago.  NewFNP supposes that murdering two people loads you up with bad karma.  Further felonies do not help.

OK, back to newFNP.  In her new job, newFNP is surrounded by overachieving braniacs.  Hell, in her clinical job as well, but in her clinic most people are content with providing clinical care.  In her new job, clinical care is part of what you do when you aren't taking an 8AM course in genetics as a fun refresher or being a RWJ Clinical Scholar or writing new research proposals.  NewFNP is in the fucking thick of academia in her new gig.

To newFNP, academia is like her fantasy world of smart people just getting to be smart and do smart things and make smart geeky jokes about acetylcholine and dopamine.  It's where miracles happen - where genomes are sequenced and viruses are isolated and treatments are cutting edge.

So newFNP really has a lot of opportunity to grow in her career.

The thing is, newFNP isn't sure how much she wants that anymore.  Sometimes newFNP just wants to read Go Fug Yourself or For Whom the Bell Tolls or the New Yorker.  Sometimes she just wants to get her teeth whitened or her face facialed.  She wants to go to a movie or a Weezer concert or the opera.  Or she wants to write here on her blog, which she fully acknowledges is not advancing the science in any way but brings her a lot of joy.  And what if she wants to have a baby one day?

Recently, newFNP's new supervisor mentioned that he hasn't been to a movie in years.  Incredulous, newFNP asked why.  He stated that he doesn't have time.  No time?  For a movie?  Not even for a George Clooney movie?  That is not the life for newFNP.

And newFNP feels a little guilty about this.  Like she is letting her new boss - of three weeks - down.  Like she isn't living up to her potential.  Like she is a big flake for not taking on more and more responsibilities.  

But, for now, she'll just go read some Hemingway and put her professional neuroses to bed for one more night.

New Job's Eve

NewFNP is nervous.

Sure, change is good, it helps/forces you to grow and learn, it broadens your horizons, it affords you a bigger paycheck and a shorter commute - at least in this instance.  But, fuck, change can suck.  Role transitions are challenges, even when we are prepared for them, even when we have been longing for them.  Being new anew.  Learning each and every aspect of one's position again. 

All of newFNP's friends and family are telling her that the new job is perfect for her - it's organized, protocol-driven and academic in focus.  Hell, that's a fairly decent description of newFNP herself!  

But, ugh, change.  Even though her new supervisor is all about easing newFNP into the job, there lurks that part of newFNP that is worried that she will fail.  Why would she fail?  Who the hell knows, but she's still scared of it.  

NewFNP saw some movies this weekend, bought some flattering black trousers and designer jeans and is enjoying her last night of vacation with a glass of wine and some EKG review.  

Shopping, wine, George Clooney and studying: something(s) old for tonight, something new for tomorrow.

Phone-y baloney

There are maybe two cell-phone conversations which newFNP would like to overhear.  

One goes like this, "Hey Brad Pitt, this is George Clooney calling.  I am absolutely awestruck by the beauty and witty repartee that I have been enjoying with this lovely NP sitting in front of me.  I do believe that I shall fly her to Lake Como on my private jet and bed her."

The other may be something along the lines of, "What - they are giving away free flattering Theory trousers and cashmere sweaters at Bloomingdales at exactly 5:00 today?!?!"

What newFNP does not want to hear is your bullshit whatever conversation while she is attempting to get a health history on your two-year old kid during his physical exam appointment.

Can you hear newFNP now?  Hang up your goddamn phone!!!

For a solitary in-exam-room-phone-pick-up that is quickly ended with the words, "I can't talk now -- the newFNP is in the room," newFNP grants you a pass, but is nonetheless displeased.

After the second, third and fourth times, newFNP believes you to be unacceptably disrespectful.  During the fourth call, as the patient's mother was repeating an 800-number and credit-card number to the woman on the other end of her phone, newFNP exited the room, stating that she would return when the mother was more ready for the exam.  As she opened the door to leave, she overheard the mother stating, "Look - you made the newFNP leave" to the person on the other end.

Come again?  The woman who called - not knowing that the mother of the patient was in the exam room - bears responsibility?  No, ma'am.  

Sorry, sister, but one is not obligated to pick up the stupid phone while the provider is in the exam room.  In fact, one should be obligated to put the damn thing on vibrate or turn the fucking thing off after the first time it disrupts the clinic visit.

For the love of all that is holy, how do people not know this?  

Yowza!

School avoidance is a universal phenomenon.   Say, for instance, you are a student at a very fancy, very name-brand nursing school and you are about to graduate and you have a horrible coma-inducing class from 5-7 PM on Thursdays.  That situation is a perfect set-up for school avoidance!!  Not that newFNP ever found herself in such a situation - she's just sayin!

Another universal phenomenon is that pre-adolescents and adolescents are embarrassed by their parents.  One day, Madonna's kids will be embarrassed by her.  Brangelina's kids will lament their misfortune at having such uncool parents.  George Clooney may possibly escape this phenomenon, but as far as newFNP knows, he is sans progeny, so we will never know.

Well, one thing that might make a kid want to avoid school is if kids in your 7th grade class made fun of your mom.  And one thing that might make kids make fun of your mom is if she showed up to pick you up, was overweight, yet wearing a leopard print halter top showcasing striated bosoms, white denim Daisy Dukes and had an unfortunate home experiment with bleach technology - 4 to 6 weeks ago if newFNP correctly noted the root growth - thus rendering her hair a Tony the Tiger shade of orange.

NewFNP remembers feeling horrified that her mom had the lamest jeans.  And they were full length and she probably had a regular sweater or lady-blouse and some sweet baby-blue high-top Reeboks circa 1985 and had respectable highlights.  NewFNP's mom was known as a cool mom and newFNP still felt embarrassed by her.  

This poor little guy must have felt really bummed - newFNP can only imagine what those sharp-tongued little 13-year olds said to her patient.  

But what it is about a parent that makes her not intuitively get that dressing like a Kit Kat Club dancer is no way to roll when you're picking the kids up from school?  Or ever!  Just throw on some sweat pants and a smart cardigan before you roll up on the middle school, for Pete's sake.

Balls - redux.

When purchasing her new car earlier this year, newFNP felt confident that it would not be tampered with when she parked it in her clinic's ghetto-esque area. Why, you ask? It is because, time and time again, newFNP noted that all around her were big trucks with flashy 16-inch rims, SUVs with the same, minivans with those spine chilling stick-figure family stickers, or piece of shit junkers with piece of shit spinning rims. NewFNP bought a hybrid, a very hybridy-looking hybrid. They are not so common or coveted in newFNP's hood.

NewFNP loves cars. In her dream world, she would have her sweet hybrid and she would have a sweet Audi S6 all-wheel drive wagon for snowboarding with George Clooney. But she would not, under any circumstances, buy a big truck, fashion a skull whose eyes glowed red when she stepped on the brakes to the trailer hitch and hang from its truck underbelly a huge pair of swinging rubber bull testes.

Yet newFNP has seen this accessory more than she would have liked to. For the record, she would have liked to have seen it exactly once, just for shits and giggles, but to have seen it repeatedly feels somewhat abusive. Does newFNP really need to be hypnotized by faux balls as she leaves work?

Who hangs these balls from their truck? Do they have female partners who deign to be seen in such a masculinely adorned vehicle? Do they feel appropriately shamed when they go to the bull-ball store and weigh the decision regarding color? Do they cup their purchase in their palms and feel pride? And - really - who chooses blue?

NewFNP knows the message that these chaps are trying to put out there. They are saying, "Do not fuck with me. Smoke comes from my nostrils when I am incensed. Furthermore, my testicles are laden with semen and my semen, if you must know and - trust me - you must, is the stuff of legend. In fact, I am quite certain that there exists a tome entitled 'La Leyenda de mi Semen.' My erections are formidable."

The message received by newFNP is more like this: I am compensating for my small, poorly functioning penis, I do not know where the clitoris is, and I drink too much.

Can't we just go back to sexy mud flap ladies?

Go Bruits!

NewFNP knows a thing or two.

For instance, she knows that she should not wear black trousers with brown shoes, even if the shoes are Sigerson Morrison and cute as hell. She knows that grown men should not wear bikini underpants. In fact, if she were pressed, newFNP would assert that no men - regardless of age - should wear bikini underpants. Not even George Clooney. Because if there is anything that could render an otherwise ridiculously handsome and obviously virile man pathetically unattractive, it's bikini underpants.

NewFNP also knows that when one auscultates a carotid artery, it should not sound like there is a frigging Harley Davidson Chopper racing through at breakneck speed. And it sure as shit should not be happening on both sides. No, the finding of bilateral rumbling carotid bruits is undesirable. In concert with a fasting glucose of 392 and a BP of 204/90, it makes newFNP's eyes glaze over and forces her to consider a career as a nail salon girl. In an upscale salon, of course.

If newFNP were to adopt a "half-full" approach, she would be gratified to observe how well one can look and for how long one can push on while one's blood supply to the head is compromised.

What's that, you say? You're dizzy? No shit.

The reason that newFNP's is able to observe just how long a person can survive with said pathophysiology is that this patient, like so many others, is uninsured. Sure, when she went to the ED after passing out in her chair for no apparent reason and newFNP called the attending physician to give a little carotid bruit heads up, one would think that this patient would have exited the hospital with, oh, let's say having had a duplex ultrasonography and an MRA. One would be wrong.

NewFNP sent off the referrals today. Frankly, until this lady gets health insurance, newFNP is not hopeful that her condition, which clearly warrants an urgent evaluation, will be so.

Did newFNP mention that this patient is 57 years old? Not exactly a spry fifty-seven.