newFNP couldn't agree more

In general, newFNP's clinic reserves Fridays for pediatric well-visits and follow-ups. However, as we are not complete a-holes, we do let an occasional adult in for pressing health issues.

NewFNP was treating a lovely 34-year old woman today for a UTI when she said, "You should be a model, not a doctor." True, so true - doctor/nurse practitioner distinction aside, of course.

Who looks pregnant now, motherfuckers?

When it's good to be newFNP

As newFNP's readers know, newFNP has her good newFNP days and her bad newFNP days.

NewFNP was so thankful today to spend 10 minutes educating the mom of a 12-month old about why we are changing him from QID Albuterol to BID Pulmicort Respules and prn Albuterol. NewFNP really felt like she empowered this mom to control her kid's asthma and got some buy-in about just how crucial this is. The mom was grateful and newFNP was invigorated.

NewFNP felt like it was one of the best FNP encounters she has had in such a long time.

Or maybe newFNP ate scrambled some Valium in her egg whites this morning and this lovely encounter (one of twenty-something) was all a glorious dream.

Don't be a fool - stay in school!

NewFNP loves school. She wishes that she could forever just go to school. The life of a student - a grad student that is - is one which suits newFNP to a T. Some classes, some studying/snacking/coffee at a local coffee house with her pals, some hitting the awesome 7-story gym provided to her by her educational institution, some thinking, contemplating, practicing, reading... you get the picture.

Now newFNP knows that high, middle and primary schools are not as much fun as grad school, yet they are probably more important because they are a platform, a springboard if you will, to bigger and better things.

Thus, newFNP's newest pet peeve: parents who are not teaching their kids to value school. It's always been an issue for newFNP, but this past week has been the worst. Take you kid to school, take their fucking TV out of their room if their grades are in the pooper and don't pull them out of school for 2 months to go visit relatives in another country. NewFNP just read an article in The New Yorker about parents pulling their kids out of an urban high school in Denver in order to take them to dry wall jobs. To newFNP, that is unconscionable.

Lest anyone think that newFNP was a child of privilege, let newFNP assure you that that is not the case. NewFNP's family simply taught newFNP's generation that we would be successful in education and life. The strategy worked.

NewFNP is not insensitive to the fact that people need to pay the rent. But here, in newFNP's frigging expensive city, if you don't want to live paycheck to paycheck, you had better get an education and a good job.

So go to frigging school!

And away you go!

NewFNP has noticed that it is, in fact, getting easier to know when to send patients to the ED. NewFNP has harbored a fear of over-reacting and sending patients to the ED when they are merely suffering from gas or a plateful of questionable seafood.

It's a fault of newFNP's training program, frankly - not enough experience with emergent patients.

Anywho, newFNP send yet another patient to the ED today. This lady weighed 350 pounds, had a smoking history of 35 pack years, sat for a multiple-hour car ride six days ago and has had exquisite left calf pain for 4 days. No relief with anything, worse with walking. NewFNP's clinic does not have the diagnostic equipment to rule out the DVT and newFNP's patient was at too high a risk to watch and wait. Was she short of breath? Hell yes she was, but who's to say whether it's from the magical combination of obesity and smoking or not? Her lungs sounded fine, but who can trust an auscultation through 2 inches of adipose? Did newFNP feel a cord, a pulsating mass, an area of increased warmth? She did not. However, this woman's calf had the circumference of a watermelon. NewFNP couldn't feel a thing.

Now, in general, newFNP hates to be wrong. However, newFNP hopes to be wrong about this patient. NewFNP hopes that she has some muscle spasm/arthritis/hypersensitivity - whatever. She just has to be sure. Yesterday, newFNP send a 16-week primip to the ED because she couldn't find a FHT after multiple attempts. Thankfully, the ED saw the heart beating on ultrasound. NewFNP is very thankful that she was wrong and doesn't want any patient to have a bad outcome to prove her right.

Vacation all newFNP ever wanted

NewFNP is counting down the days until her 2 week vacation. A little over a month and she will be jetting to a far away and exotic land - a land requiring both passport and visa, a land of monkeys and cows roaming the streets, a land requiring prophylactic Cipro.

But until then, newFNP continues to toil day in and day out. She dutifully educates regarding URI's and asthma. She skillfully performs paps as fast as possible. Just like a bank robbery - get in and get out. She supportively advises diabetic patients to lay off the orange soda, Hot Cheetos and multi-tortilla meals.

And today, she felt her first-ever silicone-injected buns. NewFNP's patient had visited another country for breast implants, rhinoplasty, Jolie lips and gluteal enhancement. If newFNP's readers have never felt silicone injected buns, they feel lumpy and hard. Perhaps newFNP's patient is the exception and perhaps silicone gluteal implants feel nice, but silicone injections do not. They especially do not feel nice when they are harboring a large, erythematous, taut abscess. But abscesses are old news to newFNP readers by now.

What is new to newFNP is the technique of packing the wound using a long q-tip to introduce the wick. For all these months, newFNP had been hoping and praying that her closed tweezers wouldn't accidentally open inside of her patients. Is it wrong to hope that newFNP will get to use her new technique soon?

And here's a little note to any male newFNP readers who might not have a clue. When someone like newFNP walks in the room and you give her a big hug, ask how she's doing and acknowledge that is has in fact been quite a while since you've had an appointment, the next thing out of your mouth should not be "Are you pregnant?" A good rule of thumb is that if there is a head sticking out of a woman's vagina, it's likely that she's pregnant. If it's 10-15 days after Channukah, Christmas, newFNP's birthday and new year's, it's a brilliant idea to cut a sister some slack and let the salads and gym kick in a bit.

Seriously, what the fuck?

Happy Holidays

NewFNP would like to institute a rule firmly stating that her schedule the week before Christmas and, equally as importantly, newFNP's birthday can accomodate only well visits and patients who would like to sit and chat about ways to keep healthy throughout this holiday season.

Patients who should bypass the tiny community health clinic and go straight to the emergency room include those who are a) new to the practice and b) 80 years old and c) having chest pain and dizziness and d) apparently carrying a right-sided heart the size of a Plymouth around in their chest as evidenced by ekg tracings. Shame on newFNP for forgetting to share that this gentleman also had inverted t-waves. At least the decision to send a chap like that to the ED is an easy one.

Similarly easy in the "A/P" department is a woman who is being seen for itchy eyes and has a blood pressure of 150/110 who casually notes that she has been snacking on ice for the past year or so and whose hemoglobin was an eye-popping 3.4. Note: blood should not be pink and watery. Merry Christmas and Happy Hanukkah - you're getting a blood transfusion! Hell, maybe even two!

As for newFNP, she has five consecutive days off and she frankly needs it. Burnout, baby, burnout. Five days should provide newFNP with a fresh outlook and, considering the season, perhaps some new fashions with which to create a vibrant return to the 'hood.

Heavy metal

Amongst many other ills one might see in an economically depressed community, newFNP's clinic sees a lot of children with elevated lead levels.

Now, when newFNP was in school, she was taught that it was the 18-month old child snacking on deliciously sweet paint chips off of brightly colored Mexican pottery or the child in an urban setting who lived next to a freeway/refinery/#2 pencil factory who was at risk for lead poisoning. In newFNP's clinic, we have another lead source: tamarind or 'chili' candies.

Now, newFNP is an unabashed sweet tooth, but she has never developed a taste for the chili candies. Little did she know that she was preventing herself from lead exposure. If she had developed this taste, she would be able to buy such candies by the bag-full from her local ice cream truck, the corner market or the streetside vendor. The lead is plentiful in newFNP's hood!

Getting these kids off the chili candies can be like getting Barry Bonds off the 'roids. According to the parents newFNP sees, it's the grandparents who are the tamarind-lead pushers. It's always those who you least expect!

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.

On Call

NewFNP hates being on call for several very valid reasons.

One reason is that, for some reason, patients do not hesitate to call at 10:00 PM to cancel their dental appointment for the following day. After a glass of wine, newFNP could not give a shit whether or not you cancel your appointment and she most certainly does not want her private evening time disturbed by this mundane request. She also wonders who in the hell thinks to call the after-hours phone to cancel their appointment! NewFNP knows that many of her patients are not savvy and wishes that she was allowed to simply hang up on them. Alas, there is a record of who is on call and newFNP is still interested in maintaining her employment.

Secondly, newFNP has to cart the stupid call phone everywhere she goes, including the gym, dinners out, H&M, JCrew, etc. What the hell. Please, leave newFNP to her elliptical machine, hamachi carpaccio, $12 t-shirts and $150 cashmere v-necks in peace. NewFNP had 19 calls yesterday. Nineteen. One was for a medical reason. Eighteen were front office issues.

Finally, in newFNP's clinic, clinicians are not compensated for their on call time. If newFNP were compensated $5 per on-call day, she would have 3 new cashmere sweaters per annum. Now that would make the call experience much more worth it.

The three D's

NewFNP apologizes for the recent silence, but she has moved (homes, not clinics) and is just settling in to her new place. Ahhhh.... home sweet apartment home.

Anyway.

NewFNP must have previously noted how patients' chief complaints come in waves. One day it's nothing but pap smears - one vag after another. The only difference is the amount of hair. You might be surprised to know that a 250-pound woman has the flexibility to get a Brazilian but they do! The next day, one might be swimming in abscesses and chalazions. Frankly, it's uncanny - do newFNP's patients all know each other and coordinate their visits? Perhaps they figure that newFNP will really be on her game if they all come for the same thing on the same day. Suckers!

So newFNP just had the diabetes and depression day. Some patients even had both. Now, newFNP is no expert on either, but can manage each effectively in the primary care setting. NewFNP admits that she is a little dodgy when it comes to changing for oral hypoglycemics to insulin, but she has no fear regarding starting an adult patient with depression on an SSRI. But one after the frigging other for eight hours? Fucking hell. NewFNP thinks of her mental health colleagues and is so thankful that there are people in this world who can address these sometimes debilitating depression cases. Because newFNP sure as hell cannot during her 15 minutes. The diabetes/depression day is not a rewarding one for newFNP. It just doesn't make for a fun clinic day.

That is until newFNP was rewarded for her diabetes/depression diligence with The Third D: Dookie. Now, newFNP is no stranger to euphemisms for the act of moving one's bowels. She generally, however, reserves 'dookie' for elementary school students and not for 38-year old men. NewFNP truly attempts to be professional during her visits with patients, but then someone says something like this, "Yeah, I used to dookie like 3 or 4 times a day, but now I maybe dook once. Maybe twice, but I used to dookie a lot." All that newFNP heard was "dookie, dook, dook, dookie, dook." Oh, it was awesome. NewFNP was biting the inside of her lip in order not to start laughing.

The Dook. NewFNP will never forget him.

Get out the vote

NewFNP's clinic had a little excitement today.

No, newFNP is not speaking of the large anal warts she saw, nor of the 29-pound 13 month old whose parents state that they give her about 80 ounces of whole milk per day, in addition to both chocolate milk, juice and the occasional soda.

Nope, newFNP's clinic had a visit from our state's democratic gubernatorial candidate. In what newFNP considers a 'preaching to the choir' get out the vote effort, Mr. Candidate did a little walk through, hand-shaking, baby-kissing visit complete with secret service and television cameras. NewFNP has already voted for this underdog thanks to the ole absentee ballot, but she was glad to see him seeing a side of our city that many politicians would love to - and largely do - ignore.

Thank goodness newFNP was still rocking the sleek blowout from her star hairdresser and was wearing a smart outfit today!

MRSA! MRSA! MRSA!

NewFNP has had some tough patients this week.

There was the 80-year old with CHF and hepatic congestion. Do they make liver sudafed because we need to decongest that bad boy!? NewFNP is decongesting that old liver and treating the CHF with good old-fashioned furosemide, which should really improve her urinary incontinence. Sorry about that.

Then there was the lady who was adamant that newFNP had not refilled her Relpax last month. NewFNP remembers the conversation in which she said that she would refill it. NewFNP wrote in the chart that she refilled it, but did newFNP hand the medicine to the patient herself? No, she did not. That responsibility falls to our dispensary clerk, who is sweet yet lacks a certain something - let's call it IQ/ability to multi-task/grace under pressure. It is not out of the realm of possibility to think that newFNP's patient perhaps did not receive her medications. However, newFNP has to trust herself and her employees and, thus, did not refill the med. NewFNP's patient was practically homicidal. It was not an enjoyable experience. Yes, newFNP knows that you are not stupid. Of course, newFNP appreciates that you are not a liar. Yes, newFNP understands that you would like her to supervise every interaction that occurs between all staff members and patients of the clinic. Sadly, newFNP has 29 other patients to see. NewFNP apologized, of course, but our relationship is damaged.

NewFNP hasn't had too many patients get mad at her. It was a drag, but newFNP had to stick by her staff because there was no clear mistake. The documentation stated that the patient received the medication. Bummer.

In other news, apparently the power of the blog is beyond what newFNP imagined. After posting that she hadn't heard from clinic B, newFNP received an e-mail asking her to interview... this Thursday at 9AM. This e-mail came in one week after newFNP's e-mail went out. How about some advanced notice for schedule clearing purposes? We'll see. We'll see.

And finally, check out this article on slate.com about antibiotic resistance.
http://www.slate.com/id/2152118/
Not a day goes by during which newFNP does not chastise a patient about antibiotic misuse. Come on people! Get with the program!

Was it something I said?

NewFNP feels like a rejected internet dater.

After being sought out via e-mail to interview at community health clinic B, newFNP replied to said clinic's Assistant Medical Director using the same medium, stating that she would love to interview, knows of the great work clinic B does, etc, etc.

That was a week ago. Nothing. Is newFNP P.N.G. at clinic B without even knowing it?

Oh well. NewFNP hears that community health clinic B pays shit, so that wouldn't work anyway. Since graduating, newFNP has noticed that many of her conversations with her late 20's/early 30-something friends focus on paying off debt, saving for a down payment, paying off private loans super-ASAP, how the fuck anyone ever buys a house, etc. Therefore, newFNP certainly cannot earn less than what she now earns. Seriously, newFNP still drives the same piece of dump she drove in grad school and rents an apartment.

So screw you clinic B! NewFNP will make the most of clinic A for now. At least she has some good stories to share.

What to do, what to do

As many of you know, newFNP has been experiencing distress at her place of employment as of late. This distress led newFNP to forward her CV to two of her public health type colleagues who are, as they say, connected.

And now newFNP has a job interview at the Cadillac of community health clinics.

Here is the conundrum. There is never a *good* time to change jobs. There are times that are worse than others. For example, newFNP has a three-week vacation planned in February. Is it a bad thing to say, "Oh, and BTW, I'm going to need to take February off. Problem with that?" NewFNP thinks that is not ideal. Secondly, newFNP let her CPR certification lapse. Fucking hell because now newFNP has to sit in that MF-ing course all over again. Double fucking hell because it looks flat out bad to let such a thing lapse when applying for new employment. Thirdly, newFNP's clinic just lost a provider - no big shock. This does, however, cause extra stress on the existing staff.

Finally, newFNP really likes and respects the MD with whom she works. NewFNP will need to excuse herself from work for a half-day to attend said interview. NewFNP wants to tell her MD, but doesn't want her MD to think she is a big ship-jumping a-hole. Ay ay ay. And newFNP is not even sure that she wants to leave her fucked up community health clinic for a more posh community health clinic. This posh clinic is at least 15 minutes further from newFNP's new apartment and, in newFNP's city, that could be a real problem.

NewFNP has about 10.5 hours to figure this all out.

Hard times are spreading...

Oh, has it ever been rough in newFNP land. NewFNP has had nothing good to say about work. No funny stories, no frustrating patients. Wait, did newFNP just write that? Of course there have been frustrating patients! But newFNP has been too discouraged to share them with anyone.

You see, newFNP's Board of Director's voted down all of the clinic employee raises. NewFNP's clinic manager continues to jam the clinic with too many patients. NewFNP had a size large bloody speculum fly out of a vagina at her yesterday (lesson: no matter what - hold onto the speculum). Oh, the velocity!

In short, newFNP feel overwhelmed and underappreciated. Maybe newFNP has too many entitlement issues. Maybe she should look at her job as just that - a job.

But that is *not* how newFNP sees her role. NewFNP is not a telemarketer. She has chosen a career that values humanity and that seeks to promote wellness. NewFNP wants the agency for whom she works to value her in kind.

And newFNP can't stress it enough, but she needs cute shoes and some new Joe's Jeans!

Stay away from the windows

It has been an exciting few days in newFNP land.

In addition to the minimum 27 patients per day newFNP has seen this past week (range 27-34), we had a little drive-by shooting fatality/car crash in a too-close-for-comfort location. And by that, newFNP does mean visible from the front door of the clinic. NewFNP was all for closing up shop that day but alas - once the fun and games of clearing away the body and the cars was taken care of, all returned to normal. Only the disconcerting knowledge that newFNP does, in fact, work in the hoodiest of hoods remains.

Thankfully, newFNP had an unexpected treat today. As she deftly moved around her patient to partake of a thorough lung exam, she was treated with a rare sight: a mullet. A wavy mullet. Others might not find joy in the mullet, but newFNP was thrilled! It's not so often that anyone rocks the Billy Ray Cyrus these days!

It was a high in newFNP's achy breaky day.

Ahhhhh......

NewFNP hates to repeat herself, but it is tough to deny that the shit that comes out of a kid's mouth can brighten one's day.

A little background. NewFNP is averaging 30.3 patients per day this week. This is a fact that would give her CEO a big boner but makes newFNP want to stab her eye with a used needle, repeatedly. NewFNP is looking in every corner of every room for the silver lining, but newFNP is fed up. One might even say that newFNP is fucking fed up.

So thank goodness for little miracles, right? And it is unusual in newFNP's life that miracles take the form of fat 9-year olds, but it seems as though miracles do indeed work mysteriously.

This chunky guy was midway through his physical when newFNP instructed him to lie down for the old abdominal exam. Reclined comfortably, he closed his eyes, stretched and sighed, "Ahhhhh, I knew this day would finally come......" He was so serene and sincere, as though he had stepped into the day spa. Or did this patient think he had stubled upon the Best Little Whorehouse in Anonymous Urban Center?

As his mom, older sister and newFNP were chuckling, this Hugh Hefner protoge continued. "I knew that one day I would be here and be examined thoroughly." Now, newFNP knows that this little kid did not intend for his comment to sound creepy or weird - let alone pornographic - and he probably didn't even intend for it to be humorous. But he indeed did receive a thorough exam and is off to urology as a result. Did his big genital fat pad eat his testes or were they never descended to begin with? That is for Dr. Penis to decide.

There was a distinct lack of awesome little kid comments today, however. NewFNP could go for one tomorrow. NewFNP could also go for a day with 20 patients, a new Miu Miu handbag and some raspberry-colored Marc Jacob's patent leather wedges. Alas, newFNP thinks that the wedges are a more achievable desire than is a light clinic day.

Office staff rant

A tough thing about being newFNP (or supervising MD or co-worker NP) is that there are no other employees in the clinic as responsible or as knowledgable as you. In some ways, that's fine. In other ways, it makes newFNP want to yell at people and throw her pens at them.

NewFNP's biggest pet peeve in not having labels in the chart.

NewFNP is the third stop in the clinical flow. First stop - front desk. Second stop - MA/vital signs. Third stop - newFNP.

As evidenced by the above written flow chart, here are at least two people ahead of newFNP who can open the chart and see that there are, in fact, no labels. Ultimately, the front desk needs to take a split fucking second and look in the chart. Are there labels? No? Print them out!

Ten minutes later, when the MA writes down the chief complaint and sees that there is no label with which to identify the patient on a new progress notes page, she then has the opportunity to ask the front desk to print out some labels.

Now, newFNP is not sure how often the aforementioned scenario occurs, but she is quite sure that it did not happen three times today, a day in which newFNP was responsible for the care of thirty-four patients. On such a day, newFNP finds it difficult to be polite when wasting precious minutes of her time to go do someone else's job. It is not as though newFNP has neglected to mention this ever-present need for labels to all clinical staff during weekly staff meetings. To the contrary, time and time again, newFNP has pleaded with her co-workers to throw her a fucking label bone. Alas, no.

Ranking second on newFNP's list of pet peeves is incomplete or an absolute lack of lab results in the chart when a patient's clearly stated CC is "lab results." Should it ever happen? No. Should it happen daily? Hell no. Does it? Shit, yes it does. This causes newFNP to hunt down her MA and request the results. Sure, newFNP could find them faster herself, but fuck that just on principle.

There are many other things our MA's miss. Some of it a simply a lack of knowledge and newFNP is not going to fault them for having next to no education. However, newFNP attributes a decent amount of MA oversights to sheer laziness. And newFNP is pissy about that. NewFNP has struggled all year with the fact that she is working like she is on the chain gang all day long while she sees other employees looking on MySpace and taking 10 minutes to figure out from which fucking fast food restaurant everyone wants to order lunch.

Being at the top of the intellectual food chain in one's community health clinic is at times a welcome responsibility and a frustrating burden. NewFNP sincerely believes that it would not take much effort on the part of other staff to ease the workload of the clinicians. Sure, we'll see the 25-30 patients per day. Just make it a frigging smidge easier on us.

Geez!

Pediatricity

NewFNP feels that she is not alone in declaring that, for FNP students, pediatrics can be daunting. Kids have high fevers, they have weird rashes that may be viral or may be frigging measles. Who knows? What new NP has ever seen measles? What parent feels confident in the diagnosis of 'viral exanthem'?

Nonetheless, pediatric visits have turned into the highlights of newFNP's day. Why, just this week, newFNP had a five year old boy laugh and scream, "You're touching my penis!" during a regular old testical exam during a well-child check. You just don't get that kind of enthusiasm during the adult exam. A four year old boy this week told newFNP several times, "You're funny." And, damn it all, that kid is right. NewFNP was having a grand old time chatting up this four year old about school, his cousin, crying, Batman - a little sample of all things important.

For all the students, newFNP thought she would share some secrets to help overcome the fear of pediatrics for you and your patient.

1) This lesson is courtesy of Sunshine, a co-ed with whom newFNP studied. New FNP uses it without fail. Kids hate the ear exam, but looking for Dora or SpongeBob in a kid's ear will greatly facilitate the process. Sometimes newFNP tells the kid that she saw Dora running to the other ear and they graciously turn and offer the ear for examination. This tool is not limited to the ears, no sir. It works on the mouth too!

2) Making an amazed face upon cardiac auscultation is a wonderful tool to get kids interested in what's up. Of course, older kids can listen to their own hearts, but the young kids like to see that you think their body is working well.

3) Knowing when you don't have to do a full exam is important. Not every well child check needs to be a head-to-toe. If kids are scared and crying, newFNP lays off, especially if they are a regular patient. NewFNP explains her lame exam to the parent, letting them know that being scared is normal and that newFNP will provide a more thorough exam when the child is not screaming and kiding under the chair.

4) Tell parents to bring the kid back the next day if you're concerned. In newFNP's experience, parents don't appear too put out when it comes to their kids' health. You can also try obvious things like oral rehydration and fever management in the office. Duh.

"You're touching my penis!" Ah, good times.

Holiday! Oh yeah, oh yeah! Celebrate!

Ah, the joy of a two and a half-day weekend! NewFNP did have to work on Saturday but then was able to luxuriate in the glory of 2.5 days off. That is, until she attempted to return to work this morning and appreciated the hell that is the first day of school, which added a full 15 minutes onto her usual 20-25 minute commute, only to arrive to a waiting room with a population density that rivaled Calcutta.

It is entirely anecdotal yet positively indisputable that the first clinic day after a holiday weekend sucks donkey nuts.

Too. Many. Patients.

What happens in that one extra day during which newFNP is having brunch and playing Scrabble and cursing The New Yorker for not picking her brilliant caption that causes a 15 billion-fold increase in patients?

And the air conditioner in newFNP's clinic has bought the farm. Granted, that was two weeks ago but temperatures are soaring here is newFNP land and one would not call the exam rooms in newFNP's clinic 'spacious' or 'windowed,' thus creating a real issue with heat, smells - you get the picture. Perirectal abscess? Sitz baths and Keflex until the air conditioner is repaired. Not that newFNP would do that, but it seems a fair alternative given the conditions.

All in all, today was almost enough to make newFNP seek refuge in the suburbs. Or the spa. Or Barney's. Or perhaps just the H.M.S. Bounty.