Internal dialogue–Self vs. Self October 28, 2009

Doing rectal exam for patient with complaint of bleeding:

Says to Self: Is that the prostate that I’m feeling?

Other self replies: Ummm, nope. That’s the edge of a piece of poo in the rectum.

Self: Ok, time to do the hemocult card then!

(Both selves exit room carrying hemocult card, wash hands and then return to office to wait for results)

Self: I’m so hungry. Time for my afternoon snack!

Other self: NOOOO your fingers were just touching poop!!

Self: I washed my hands! And I was wearing gloves. There’s NO way that poop is on my hands.

Other self: Your finger still feels warm from the patient’s rectum! Don’t touch the snack!

Self: My hands are clean, dammit! I’m hungry and I need to eat this apple.

Other self: Disgusting!

Self: What if I use this clean washcloth from the supply closet to hold the apple? Then I can eat it without touching it.

Other self: Well…ok, I guess. But only because I’m really fucking hungry.

That is how my co-worker came to find me in my office, hurriedly eating an apple wrapped in a washcloth.

A happy story October 23, 2009

Today I had the pleasure of witnessing the rare and elusive “successful patient intervention.”

Last week I saw an elderly man and his adult son.  The man had a complaint about a rash in his groin.  When I had him take off his pants, I wanted to cry.  Not only did he have a terrible, raw candida (yeast) infection in the groin, but his personal hygiene was terrible…to say the least.  Apparently his wife had gone into a nursing home some time ago and the patient had stopped bathing regularly after that.  He lives independently, which is great, but with no one to help him in the bathroom his cleanliness had gone downhill.  His adult son is sweet, but for whatever reason (modesty?  embarrassment?) he was unaware of the extent of his father’s skin problems.

We had a long discussion about what the patient needed to do to help his skin heal.  He was delighted to hear that he could buy adult-sized wet wipes to use daily instead of having to take a bath or shower every day.  We also talked about getting a shower chair, installing grab bars in the shower or using a sitz bath over the toilet after he used the bathroom.  We discussed how to dry skin folds carefully, and about using Nystatin powder twice a day (god love that nystatin, it’s a freakin’ miracle drug).  He returned today for a recheck…and his rash is almost gone!  It went from scary to innocuous in one week.  I was so pleased at his progress when I viewed his genitals that I exclaimed “Wow, look at that!  It looks fantastic!”  (To which he replied, smiling coyly, “It does?”)

It feels good to have actually helped someone solve a problem.  And it also felt good to have a genuinely short, uncomplicated visit.  And the patient felt good that his groin no longer felt like it was on fire.  Everyone wins, yay!

Three times a day is…whew October 20, 2009

My colleague at work was telling me about a recent patient. The woman was in her early 30’s with a chief complaint of vaginal discharge. During the HPI, the woman remarked that she has sex (ie: intercourse) 3 times a day, every day. Holy jesus, that’s a lot of sex! Of course, the first thing that my colleague did was to inquire if there was any element of coercion in this robust sex life. No, said the patient, I like having sex this much. Ok, we’ll say for the sake of argument that there is no pressure from this woman’s partner to have sex multiple times per day. How does one have the time or energy for this? Perhaps she has bipolar and is in a manic phase? Perhaps she is a recreational methamphetamine or cocaine user? Perhaps she is the mythical porno woman who needs no foreplay and loves a quickie at any time of day? “Sex 3 times in a day” makes me think of a romantic weekend vacation with a hot new lover…it does not make me think of daily life. It just seems unsustainable. How would one work that into their daily schedule? Morning, afternoon and night? Would you have sex between changing out of your work clothes and sitting down to dinner? Or maybe between dinner and prime-time t.v.? (For those who may be wondering, this patient did in fact have a job, which makes 3-times-a-day sex even more impressive). Time is a factor, so maybe her partner is a minute man. Sex 3 times a day at 2 minutes a pop only adds up to 6 minutes, which seems pretty doable but not very satisfying. Maybe twice in the morning and once before going to sleep? Or perhaps “3″ is an average and some days she has sex once and other days 5 or 6 times? Oy, it makes my vagina feel raw to think about it.  Of course, if she has a vagina of steel and a libido to go with it, more power to her!  I wonder if her partner ever finds it hard to keep up (pun intended).

And for those folks who wondered about the vaginal discharge, apparently she had a wicked case of BV and cervicitis. The treatment plan? Metronidazole and pelvic rest. Take that vagina on a sabbatical, lady. Let the cervix heal. And then you can go back to your herculean sex schedule.

Best quote of the week October 11, 2009

Patient, describing her hip pain:

“So it hurts when I do this (external rotation) and it hurts when I have sex–you know, when I open my legs.  And I can’t even ride a man anymore!”

Runner-up for best quote of the week from woman with vaginal discharge: “I can tell that I’m having discharge because whenever I sit down my pussy goes ‘bllllthpppt’ (raspberry noise)”

Mmm, creamy October 6, 2009

Me: I see you have some upcoming GI appointments.

Patient: Yes, my Bavarian swallow is scheduled in November.

Me: Uh-huh, I did see that they booked you for a barium swallow.

Patient: I have to go back and see that GI doctor after I get my Bavarian swallow.

Me: Yes, we do want to follow up on the barium swallow

Patient: That Bavarian swallow thing, does it hurt?

Me: No, the barium swallow doesn’t hurt. (thinks to self: Unfortunately it’s not as creamy and delicious as it sounds.  Mmmm, I could really use a donut right now)

Continuing education, I luv you October 5, 2009

I took a few days off of work for one of my favorite professional diversions–a conference! I’m kind of a conference whore, I guess. In an average year I attend about 3 conferences, and this year the total is going to be 6 (3 as an attendee, 3 as a speaker). I love learning new things. I also love the associated perks–traveling to another city, excused absences from work, schmoozing with other healthcare providers, being reimbursed for the expenses out of my continuing education account…how could it be better? Ok, maybe if my expense account were a little bigger–then I could have gone to the WPATH (World Professional Association of Transgender Health) conference in Oslo, Norway. But apparently a gal in the community health field can’t have everything.

This week I attended the Gay and Lesbian Medical Association (GLMA) annual conference in Washington DC. As proof of my status as both a health nerd and a big homo, I spent the days saying things like “Ooh, I’m so bummed that I’m going to miss the anal health update!” and “Oh goody, a session on syphillis!” without a hint of sarcasm.  It’s great to be around people who actually care about things like “older lesbians and cancer”. And the GLBTQ med students are adorable.

Here’s a continuing education haiku:

Thrills me to no end

listening to lectures and

missing two days work!