Period

NewFNP remembers her menarche all too well.  She was preparing to go to swim team practice while spending the summer with her grandparents.  Her coach, Aaron, was hot and newFNP was pretty heavily working a schoolgirl crush.  NewFNP's mom had had "the talk" with her some years before so newFNP knew what was happening and she was none too pleased.  

First period?  Swim practice?  Hot coach?  Bad.  

NewFNP's grandma, after congratulating newFNP on her passage to womanhood, called newFNP's mom to tell her of the news.  NewFNP's mom seemed happy and proud, clearing indicating to newFNP that all adult women were insane not to recognize menarche for what it felt like at the time: a disaster.  The only thing that could have made that experience worse for newFNP would have been if she would have been at her dad's house.

Which is exactly where newFNP's young patient was when disaster struck.

This ten-year old girl spends a lot of time with her dad and he brings her to each and every of her clinic appointments.  NewFNP knows them pretty well and thinks that this man is one of the best fathers newFNP has ever met.  Generally, he is really clear about his concerns or needs when he brings his daughter to the clinic.  So when he came in and told newFNP, in Spanish, that his daughter was here to see newFNP because she 'was developing', newFNP didn't quite catch his meaning.  When he told her that his daughter was now 'a miss', newFNP was equally stumped.   Bilingual newFNP?  Yes.  Bicultural?  No.  It took his daughter saying "I got my period" for newFNP to get on board.  

Dad asked newFNP to do some explaining and exited the room.  NewFNP let her patient lead the conversation.  There were some basic questions.  Will it hurt?  Should you carry supplies with you?  Will it come every month? Why do girls have their periods?  

Now, newFNP has never really given 'the talk' before and her recollection of her mom's talk elicits only memories of embarrassment and desires to return to her room and listen to some Duran Duran albums.  

So newFNP just talked about it medically.  She told her young patient that girls have periods so that they could have babies when they are older.  Her patient wondered how blood and having babies went together.  NewFNP talked about a nutrient-rich environment for babies to grow.  She drew a picture of ovaries, a uterus, a cervix and a vagina.  Clearly, newFNP will have to work on her talk and her art if she ever has daughters.  

The young girl looked at the drawing and took in all that had been discussed.  She took a pensive pause and asked newFNP, "Does the baby come out of the same hole as the period?"  NewFNP responded that it did.  Again, her patient paused although it was clear to newFNP that her mind did not.  "But that hole is small," she said, "and babies are big."

Amen, sister.  Amen.  

She went on to ask, "Why does having a baby have to hurt so much?"  No shit.  NewFNP has asked herself that several times.  And then she immediately downs her birth control pill.

We talked about bodies being made of muscles; about how even though we have periods, we don't need to have babies until we're older; about breasts and sports and school and growing up.  

She left, questions answered, ready to go back to being a ten-year old girl.  Dad shot newFNP a look of thanks and of pride yet clearly tinged with a bit of sadness because his little girl is growing up.  It was quite sweet.  

Healing.

It would have been easy for newFNP to just blow off the attitude of the almost thirteen-year old obese boy who begrudgingly attended his well child visit with his mom today.  Eyes steadfastly examining a single spot in the floor, his 213-pound frame turned away from his mom and from newFNP, he initially refused to respond to newFNP's questions or to his mom's exasperated pleas for the responses.

"You see, Doctora?" she lamented.  "This is how he always is."

NewFNP cares for this boy, his two younger brothers, his mom - who has diabetes - and his grandma who also has diabetes and who has had two strokes.  His mom cares for herself, her mother and her four children as best she can.  One older boy is on house arrest.  As newFNP flipped back to the last physical, she saw in her handwriting: father incarcerated.

NewFNP knew that this attitude was about that.  She asked the patient if his dad was still in jail - he is.  She asked him if that was why he was upset.  It was.  She asked the patient's mom to leave them alone, not quite certain how to broach the subject of the kid's attitude and his father's incarceration.  These topics are difficult for newFNP - she often feel like the emotional equivalent of a bull in a china shop when she has to discuss them.

True to that expectation, newFNP's start was rocky.  She asked her patient, whose emotional pain was weighing heavily in the room, to please look at her.  He refused.  She told him that it would mean a lot to her if he could just look at her.  He made a micro-movement toward her, decided against it and again faced the floor and told her no.  

NewFNP said, and in writing this she knows that it is harsh, "OK, so you just want to sit here and be a jerk?"  He said yes.  This affirmation opened the door for newFNP to ask him who has told him that he is a jerk.  

And the floodgates opened.  NewFNP is not sure what she would have done if they had not but it doesn't take a psychic to know that this kid has had a lot of negativity directed towards him.  'Jerk' may have been tame compared to other names he has been called. 

NewFNP spent the next twenty minutes listening to this devastated kid cry about how he misses his dad.  It was absolutely heartbreaking.  He doesn't want to go to school because his dad used to take him.  He doesn't want to go to the park because he sees all the other kids with their dads.  When someone picks on him at home, no one is there to defend him like his dad used to.  He is about to turn thirteen and all he wants for his birthday is to visit his father in prison.  He is concerned that he will be deported and that he won't see him again.  His uncle is mean to him, tells him bad words and to "calm the fuck down."  His aunt yells at him.  His mom is frustrated with him.

NewFNP was, frankly, not sure what to do.  Obviously, this kid is at high risk for school failure, perhaps for criminal behavior given that his brother and father both modeled it for him.  NewFNP knows that he is also at high risk for diabetes, that he already has fatty liver infiltration and she assumes that part of this overeating has an emotional component.  She made an executive decision to blow off the medical concerns for today - at least in part - and to focus more on his emotional decompensation.

She told him that he has already seen too much and suffered too much for his young life, acknowledged that life has dealt him an unfair hand, allowed him to grieve his loss and his loneliness.  She talked to him about his potential, about making good decisions and about how he is loved.  She told him that she saw a sweet person inside who wanted love and caretaking.  

She just let him cry and tell his story as, in the world according to newFNP, telling one's story is an important therapeutic process.  

At the end of the visit, newFNP listened to the kid's heart.  She let him listen to it - it was the first time he smiled during the visit.  She asked his permission to check his blood and ordered a cholesterol, a comprehensive metabolic panel and an A1c - just in case.  She told him that she would see him in two weeks.  The nutritionist referral will have to wait until then.

NewFNP left him in the room and spent a few minutes with his mom.  She asked her to tell him every day that she loved him.  She asked him to tell her bullying brother to lay the fuck off.  She told his mom that she was very worried about this sensitive and hurting boy.

NewFNP was e-mailing a pal from public health school to ask about mentoring programs for this kid when she heard him call her name.  She turned around and he gave her a big hug and thanked her.  

Even though newFNP thought how she was utterly powerless to change this kid's life during her encounter with him today, she simultaneously felt so grateful for the opportunity to say kind words to a troubled adolescent.  She needed that.  Clinic has been so overwhelmingly thankless lately that she had been questioning whether or not she could stay.  

Even though newFNP didn't do much medicine with this guy, she definitely did some nursing.  And some social work.  And it felt really, really good.

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?

Now boarding

There are several ways in which patients can endear themselves to newFNP.

For instance, they might express heartfelt thanks for the care they've received. They might tell newFNP how young she looks when, in fact, she is not.

Most endearing of all, they might be funny as shit in the exam room.

NewFNP's first patient of the day hit the ball out of the park when she did all three and started newFNP's first post-move work day off right!

Now, newFNP knows that it is through the magic of Nars that she looked so youthful this morning. Who the fuck wouldn't look youthful with a fresh sweeping of Sin blush across the apples of one's cheeks? However, beyond her welcome flattery, this patient was truly grateful for the care she received and expressed her gratitude freely.

It was not, however, the flattery or the gratitude which endeared this patient so profoundly to newFNP. No, it was the fact that she was the funniest historian newFNP has encountered, hands down.

This patient, a woman in her fifties, came in with a chief complaint of vaginal discharge - already one can appreciate the potential for humor in the face of a not-so-humorous condition if you are the patient. This discharge, according to newFNP's patient, had "set her back." NewFNP had never heard that turn of phrase in this context before. She is more familiar with its use in the context of something along the lines of "That new Miu Miu purse set newFNP back a car payment!" So, when evaluated in that context, newFNP understood that the discharge was significant.

NewFNP's patient went on to give newFNP details of the discharge, such as the fact that it was malodorous enough to warrant "a hell of a scrub" before coming to the clinic. In addition, it was copious enough to require the use of feminine protection.

Now, newFNP's patient had a hysterectomy some years ago and, as a result, was unfamiliar with the decades-old advances in pantyliner technology. She stated that she had purchased some pantyliners but, upon running out, could not afford another box and borrowed some pantyliners from her daughter.

"Those damn things look like an airplane! I ain't never seen a pantyliner like that - it had wings!"

Superfluous information? Sure. Welcome? Fuck yeah.

Wings.