Do that voodoo that you do

One of newFNP's struggles is to work within a culture that is so utterly different from that of her own. Generally that manifests in requests for disability paperwork or in the dramatic vocalization of pain.

However, this struggle became uniquely salient today as newFNP was completing a physical on a 41-year old man. While he has a partner and family in his home country, he has been in the U.S. for twelve years and has a partner here as well. Apparently, his original partner was none too pleased because, as he told newFNP, she put a curse on him in order to make him impotent.

And dammit, it worked.

Now, newFNP might have taken an educational trip to a forbidden island in which voodoo is practiced and she might have entered an apartment which was protected from the evil eye by a special red fabric and was receiving some kind of power from a chicken with its legs bound by a red cloth, but that is as much as newFNP knows about witchcraft and black magic and voodoo -- which is to say she knows nothing. At her fancy nursing school, they wanted to teach the students frigging Reiki, but not even an elective on traditional/cultural medical practices/voodoo? Way to be culturally competent.

NewFNP could find no physical health concern that would explain this young, fit man's ED. From his perspective, his health was non-contributory.

NewFNP probed for a psychological explanation. Was he perhaps feeling guilty for having another partner here? He stated without equivocation that he was not.

(Hell, who can blame a dude for finding another lady after twelve long years? NewFNP is having a dry spell that nowhere near approximates that - thank god - and she's considering some recidivism.)

She asked him if he would like to try Viagra. He did not, because as he explained, the problem rested in the curse.

Not sure where to take this encounter, newFNP asked him if he believed that her curse was the only cause of his erectile dysfunction. He was certain that it was. In that case, newFNP told him, it seems as though you need to find someone to reverse that spell.

And for that, newFNP is hard pressed to recommend a single practitioner.

Potty mouth

NewFNP had a completely fucking bizarro day at clinic today.

For starters, her first two patients -- both new to clinic, of course -- had schizophrenia. The second one also had a wonky eye.

Then there was the chlamydia patient -- the first chlamydia of the day. The first patient was pretty normal. However, he had genital warts that were growing in perfect projectile symmetry on either side of the glans, conjuring images of a caterpillar. NewFNP is a sucker for symmetry and, in fact, has a real aesthetic bias against asymmetry and has, frankly, never seen warts grow in such mirror images of each other in non-touching skin.

Then she had a syphilis patient and began to wonder if she had stumbled into the mental health/STD clinic.

Then she saw what felt like another 7 million patients when she came across her second chlamydia patient of the day: a 17-year old primigravida who is 38 weeks and 4 days pregnant and who had her first prenatal visit last week. Can newFNP interest you in Azithromycin?? Open wide.

Then she saw five other patients when her clinic manager and the brand new RN came in at 5:15 and asked if she would please see another patient, to which newFNP replied, "You have got to be fucking kidding me." And then she saw two more patients.

NewFNP's mouth is absolutely going to get her in trouble one day. She needs to reign it in. In her defense, however, newFNP did not have even a 10 minute break today. She peed once and texted a patient her lab results from the bathroom.

What newFNP really needs is to work in a high-functioning community health clinic with the gestalt of a tattoo shop. Barring that, though, she really should learn to just shut the eff up.

Make it a double

It is no surprise to newFNP that STDs are on the rise.  Hell - in newFNP's clinic alone, she had several cases this week!  Gonorrhea, check.  Chlamydia, check.  And repeat.

NewFNP's approach to disclosure of STDs is straightforward.  It is generally something along the lines of: newFNP called you in today because your test results came back positive for chlamydia.  NewFNP then pauses so as to gauge the individual patient's response.  Some people are very nonchalant when they hear the news as though it was only a matter of time.  Some people are angry.  Still others are shocked.

Then there are responses such as this: But she told me that she was a virgin.

Well, maybe she wasn't.  Maybe you were infected asymptomatically and here we are finding out right now.  NewFNP doesn't spend a hell of a lot of time conducting an epidemiological survey.  She treats her patient and, for chlamydia, she dispenses treatment to take to the patient's partner(s).

NewFNP brought her patient some water, his Azithromycin, as well as his partner's treatment dose.  He took his medicine, set down the cup and tapped the partner's bottle.  

"Uh, can I get two of these?" he asked sheepishly.  

Sure buddy.  Two partner treatment doses it is.  Trying to blame it on the ex-virgin.  Indeed!

Bust a capful

It is not so often that newFNP has one of those "I've never heard that before" moments.  And perhaps a vaginal exam is not the preferable circumstance in which to experience said moment.

NewFNP's patient was gravely concerned that her purportedly well endowed partner had somehow maneuvered her IUD out of position and that she was, therefore, pregnant.  NewFNP had already seen the negative pregnancy test in the chart, delivered the result to the patient and offered to do a quick check to reassure her patient that the IUD was, in fact, intrauterine in location.  

Although she consented to the exam, newFNP's patient specifically requested the use of a small speculum, which seems rather ironic given the reason for her aforementioned concern.

"A small speculum?" questioned newFNP.

"Yes," she replied, "because I use a capful."  The way in which she casually said this assumed that newFNP was in the know regarding the significance of a capful, as though the use of a capful was a secret shared amongst women across the land.

"A capful?" newFNP inquired.

"Yeah, you know, a capful of vinegar," she explained.

NewFNP puzzled expression must have clued her patient in that she was not at all following.

"To keep it tight," she explained, "I put a capful of vinegar in my bathwater and that keeps you tight."

Does it now?

Vinegar.  To dye easter eggs?  Yes.  To clean one's linoleum?  Sure.  To freshen one's coffee pot after a year of French Roast brewing?  OK.  But to keep a vagina tight?  NewFNP is quite sure that Heloise would not offer that as a hint for non-food-based vinegar use.

NewFNP recommended Kegels, confirmed the IUD placement, reassured her patient of both her non-pregnant and actively contracepting status, and went on her vinegar free way.  

Rx: vibrator

NewFNP is aware that it is wholly within the boundaries of acceptability to discuss one's sex life with one's provider.  In newFNP's clinic, however, this discussion generally consists of women telling newFNP that they are tired of having sex with their partners and are stupefied at the amount of sex a man wants.  In a 25-patient day, it is exceedingly difficult to suss out if that is because intercourse is physically painful or if it is because their partners are content to sit around and watch TV while the women clean the house & bathe the kids, etc. or if it is because their partners are just sort of remedial when it comes to doing it.

If the aversion stems from physical discomfort, newFNP feels like she can easily manage that discussion.  Not enough lubricant?  Try some Astroglide! 

If the discussion involves a selfish lover/partner, then what is newFNP to do?  There are no Dr. Ruths in newFNP's clinic and there are probably no Dra. Ruths on Telemundo.  Sadly, there is no wonder female sexuality duo a la Berman & Berman. 

But mostly, there is no time.

So what is newFNP to do when her 40-something year old first time patient, all undressed in anticipation for her pap, lets newFNP know that she just never has orgasms.  For all her life, no orgasm.  Sex feels good, but there is just something missing.

And how!!!

Now, newFNP knows that this woman is looking for direction but - hell - newFNP is not her best girlfriend.  She is newFNP!  Can newFNP just say, "Listen.  Seriously listen.  You must teach your man how to perform oral sex.  Period.  At the very least, you guys should watch some Sex and The City reruns for inspiration."

It's a delicate topic, is it not?  How does newFNP know if her patient is open to, say, the cowgirl position or assisted orgasm technology?  They simply do not teach that kind of shit in multiculturalism workshops!

NewFNP didn't say what she may have said to a member of her grad school girl gang, but did bring up some options: communicate with your partner about what feels good; explore for yourself what feels good; maybe try a new position or two; and if all else fails, follow Charlotte York's lead and buy the Rabbit and call it a day.

A very good day.

Feelin' good, feelin' *real* good

NewFNP's four-day wonder-weekend is winding down. Thus, newFNP forced herself to return to her normal Sunday routine of gym and a trip to the farmer's market.

While at the gym this morning, newFNP was perusing the current issue of The Journal of Family Practice and stumbled upon an article which sought to elucidate the role between marijuana use and the use of Viagra (sildenafil). Although the sample size was only 231 and was only selected from one outpatient practice in Brooklyn, fully 59% of the Viagra poppers did not have diagnosed ED. They were, in fact, recreational users of the little blue pill. Of this sample, 76% of them admitted to feeling a kinship to Snoop Dogg, not in relation to weapons charges or hos, but to loving themselves some weed. These stoners also noted that they sometimes procured their Viagra from "friends" or "street vendors." NewFNP is so worldly in some ways, yet so naive in others. She was just not aware that a market existed for this type of prescription drug.

Maybe A&E will do an "Intervention" about it. NewFNP imagines that the actual intervention would contain the plea, "Your ridiculously hard penis is ruining our relationshop! We never go out, we never invite friends over - we just sit around and smoke weed and have sex because of your crazy penis! I can't take it anymore and I will no longer enable you with my multiple orgasms!"

It is a stretch for newFNP to remember the days when marijuana played any role in her life, but it would have been when she was in high school and, frankly, newFNP is quite certain that - weed or no weed - teenagers are going to have sex. After they eat some Hostess and Taco Bell. Therefore, newFNP thinks that the population polled for this study is older, say in their 30's-50's, although age was not reported on.

NewFNP found the article amusing and appreciated that someone had to think of the research question in the first place. It really begs the question of the researcher, "What was that guy smoking?" Additionally, the article brought up the following questions for newFNP.

1) Who are these middle-aged guys who smoke weed? Do they still live in their parents' basement watching Soul Plane and playing air guitar, or are they just normal guys with girlfriends or boyfriends or wives and with careers and college educations? NewFNP hypothesizes the latter, but is willing to allow that the former do exist as well.

2) Where do these people buy their weed? NewFNP isn't all D.A.R.E. and Nancy Reagan, but she would be scared as shit to get busted. NewFNP will just stick to red wine. Unless you know anybody. Kidding - geez, calm down.

3) Are these guys popping Viagra because their libidos are diminished from the mary jane? Or are their libidos diminished by the paranoia that their special friends are in the DEA? Or because their ladies are all red-eyed and messed-up-haired with powdered sugar from the 6 Hostess Donette Gems she just consumed all over her t-shirt ? Or do these guys just want to experience more pleasure? Here is newFNP's null hypothesis: weed smoking = love of feeling good. Sex feels good. Maybe it just feels better when you're stoned and hopped up on Viagra.

4) Why do we still care if people smoke marijuana and why is it illegal? Just like the OGs say - regulate, motherfuckers, regulate. Don't drive stoned, don't get stoned while you're hanging out with your kids in the jumpy house at the neighbor kid's birthday party because, even though you'll really want to, you can't go in. Just think of the tax revenue we could create of we added a tax to your pack of joints? The schools would benefit! The food industry would certainly benefit. While we as a country, astoundingly, cannot seem to get behind gay marriage and tighter emissions standards, maybe we could all join hands, pass the duchey on the left hand side, and demand that we don't criminalize our weed smokin' fools!

Priorities

NewFNP is no Dr. Ruth, but she does pretty much accept that the most important body part in many a man's life is his penis. No big surprise there.

So when a 50-something year old guy presents to clinic with the chief complaint of the old johnson not working, newFNP is generally willing to help a dude out. She does, however, want to know why said johnson might be flying at half mast.

Thus, the history. Onset? Two weeks ago. Taking any meds? No. Any known health problems? No. Hmm, not much there. Glucose is normal. Chest pain? Maybe a little this morning, but none now. Next up, EKG.

This is where it gets interesting. It's not so often that one catches a guy in the middle of an M.I. but one might think to delve further into this possibility when one's EKG shows both ST elevation and T-wave inversion. When newFNP brought up this likely scenario, her patient noted that he had, in fact, been diagnosed with an M.I. a mere three days ago in the emergency department. He received some medications, but wasn't taking them because he didn't trust the doctors there.

Didn't think to bring that up, did you pal?

Well, buddy, newFNP won't be bringing your penis up with a Viagra prescription since you are actively infarcting. Now, take an aspirin and high-tail it back to the ED, would ya?

Maybe we should all take a lesson from Harlequin romance novels and embrace the notion that if you take care of the heart, my friend, generally the penis will follow.

Unless, that is, you've decroded its blood supply with Gatorade, tortillas and Sugar Babies.

newFNP writes for pleasure

Although newFNP has been in practice over a year, she is still surprised by the amount of firsts she has.

For instance, yesterday she was asked by a patient - in the hallway after the visit had ended - to write a letter on her behalf allowing her to bring her own linens to the conjugal visits with her incarcerated husband. Although she may have sensitive skin, newFNP's patient is clearly not a modest woman.

So let newFNP think. Hmm.... medical issue? She doesn't even have atopic dermatitis! Possible smuggling consequences? NewFNP is almost 100% sure that her malpractice insurance does not cover "prison break."

While considering her request, newFNP has tried to envision the sheets provided by the penal system for such purposes. Her hunch is that they are more 'army surplus blanket' than '600-thread count sateen'. All creature (dis)comforts aside, newFNP thinks that she will decline to write this utterly non-medical letter. Sadly, newFNP's patient will have to endure the prison-issue sheets and newFNP will have to deal with the resulting fungal, bacterial or viral consequences as they come.