Violence

NewFNP regularly screens her patients for intimate partner violence (IPV).  It's just one question, usually either "Do you feel safe at home?" or the not so nuanced "Does your partner abuse you?"  It is a hard question to ask, but it becomes less hard the more you ask it and more hard when the answer is yes.

When the answer is yes and you work in a super ridiculous community health center, your day will be sub-par but likely nowhere near as crappy a day as the days leading up to a patient's disclosure that the are abused by their partner.

NewFNP's responses have been varied - she has sat with a patient while the patient called a local hotline, she has referred a patient to our fledgling medical-legal partnership, she has called the police.  

But yesterday, a patient for whom the answer has been 'no' came in and disclosed that, all this time, the answer has in fact been 'yes.'  At some point, this woman had the wherewithal to obtain a restraining order.  This may have been when the abuse extended beyond her and to her oldest child.  

Like many women, she wanted her partner to change.  She wanted the abuse to stop, but she didn't necessarily want the entire relationship to stop.  Like many women, she was afraid of losing her children - a fear heightened by her partner telling her that this was, in fact, what would happen and by her complete detachment from the legal system.  

In some ways, this was an easy decision.  Children are at risk, he violated a restraining order.  NewFNP dialed the police.  Unfortunately, he had left the house by the time they arrived.  

When newFNP was in public health school, she visited a women's prison as a part of a class on family and sexual violence.  It was a life-changing experience.  In that group of women - convicted murderers - there were PTA moms and biker ladies.  There was a woman who killed the man who got her daughter strung out on drugs and abused her.  There was the woman who, after a brutal beating, killed her husband while he slept because he had been threatening to kill her and she knew that he wasn't kidding.  Mostly these women were serving life sentences. 

There are more aspects to this crime - on the batterer's side and the abused partner's side - than newFNP knows.  Issues of power, of fear, of control, of rage, of money and poverty, of fucked up childhoods, of desperation, of gender inequality, of protecting what is valuable to you.  

But these women shouldn't be locked away for life and newFNP's patient should never be in a position so desperate that homicide seems the only solution.

So ask.  Just ask.  As a provider, you might not have all the answers, but you are sure as hell equipped to find them out for a patient who might be caught between the bat and the belt.  Or the gun.  

Relationship issues

When you work with someone every day, you have a relationship with them - like it or not. NewFNP is very picky about her relationships, although she has made some questionable decisions in the past. Let's just say that newFNP is a wiser woman for them!

She is now in a relationship with a new OB/GYN at work. This OB/GYN has been in our clinic for a little under a month. NewFNP was out last week so the relationship is still a fledgling one. This relationship, however, is very unlike the honeymoon phase in other relationships during which all you want to do is make out, eat dinner and make out again. NewFNP thinks that under non-clinical circumstances, she and this OB/GYN may be friendly. Under work circumstances, newFNP is ready to snap.

In newFNP's clinic, the prenatal population cannot support a full time provider. On the other hand, the uncontrolled diabetics, depressed patients and kids with URI's provide a never-fucking-ending stream of work for newFNP while the OB/GYN leisurely sees her 10 patients per day. This pace leaves OB/GYN plenty of time to point out the flaws in care she sees in the charts, the flaws with our clinic's MA's and the flaws in systemic issues, and man alive, does she ever take advantage of all this free time. Unfortunately, the maelstrom is all directed toward newFNP while she is in the midst of charting, writing letters, filling out forms, helping MAs, etc.

Does OB/GYN think that newFNP has a fucking shred of control over any of this? Patient care notwithstanding, newFNP believes it safe to say that any input she may have into overall administrative issues is placed directly into the "whatever" file. NewFNP may exude the cool professionalism of upper management, but in her clinic, she is nothing but a worker bee.

OB/GYN's complaints struck a chord when she noted that a prenatal patient disclosed that her husband had been beating her throughout her pregnancy and it hadn't been addressed and it's our responsibility, yada yada yada. NewFNP looked through the chart. This patient had been screened for IPV at every visit, admitted to it once and was sent to the appropriate resource. Does OB/GYN want newFNP and the other providers, all of whom see full patient loads, to go Guantanamo-style on the patients in order to get information from them? NewFNP wants OB/GYN to work for a month before she starts pointing out all of our flaws. And even then, she should learn a little tact or keep her trap shut.

As newFNP was walking out the door, OB/GYN asked her to contact a patient for her. NewFNP encouraged her to ask our LVN to do that as he would be in the clinic a full hour after newFNP left. No, OB/GYN left it for newFNP. Unacceptable, but newFNP was too pissy to deal with it in an appropriate manner.

NewFNP is admittedly a little low on emotional reserves this week as her cousin died last Monday. But even when newFNP is at full reserve, she takes it very personally when other providers point out what they deem mismanagement when it is done in a mean-spirited fashion. NewFNP isn't even responsible for some of the visits about which OB/GYN is complaining, but she still takes it personally. All of the providers in newFNP's clinic strive to deliver care that rivals private practice standards given our resources. NewFNP is open to teaching and constructive criticism, but assholery will not be tolerated.

Knocked up

As a part of newFNP's continuing growth, development and work stress, she has taken on the role of prenatal care provider.

Here is newFNP's ideal first prenatal patient: 25 years old, normal weight, 8-10 weeks pregnant, non-smoker, no drugs or alcohol, taking prenatal vitamins, stable home life. She can have a cup of coffee per day because, come on, newFNP isn't a fascist.

Here is newFNP's actual first prenatal patient: 22 years old, G3P2 with a 7-month old, living in a shelter due to IPV, quit her 2 PPD smoking habit "2 weeks ago," in the 19th week of her pregnancy seeing newFNP for the second prenatal visit of this pregnancy, no prenatal vitamins, with both children in foster care, overweight and missing a front tooth. NewFNP knows that the front tooth isn't relevant, but it does paint a certain picture. Did newFNP mention that this patient was a walk-in? Of course she was! Only the non-complicated patients seem to make appointments in newFNP's clinic.

Trial by fire, this prenatal care bit.

Look at all of the opportunities newFNP has to provide education, support and care.

That is newFNP's new mantra. The old was one "fuck this" and that mantra just doesn't always work.