Reflections on growing up November 22, 2009

November is my birthday month, and it’s also the month that it starts to get really dark at 5pm. These two things never fail to put me in a reflective, somewhat melancholy mood. This year I’ve been thinking a lot about what it’s been like to have left my wild adolescence behind. I’m basically a totally respectable adult now, in my 30’s, with not just a job but a career. Frankly, it feels weird. Some part of me never thought that I would grow out of my rebellious youth, despite all evidence to the contrary that most adults do (and in fact, it’s a little creepy when adults try to maintain their youthful rebellion past their 20’s). Although you could argue that I am still fighting The Man every day with my LGBTQ-friendly community health services, it’s a very different kind of “fight the power” feeling than it was to show up at a big protest march with a bunch of black-clad anarchists. Arguably, I’m actually doing more to fight the power now, but it’s just not as dramatic.

I’m not trying to say that I didn’t want to grow up. You can only sleep on a thin futon mattress in a dirty shotgun flat for so long before it stops being exciting and starts being uncomfortable. Likewise, dancing and drinking and picking people up in bars and then going to work the next day is only sustainable for so long, and after that it gets exhausting. Now I get a good night’s sleep and march into exam rooms, wearing a white coat and authoritatively giving people instructions and diagnoses, standing in my fun-but-not-too-funky-for-work heels and pantyhose (i mean seriously, pantyhose?! i really never pictured that when i was younger), and people look at me and see someone respectable. It’s weird, I tell you. Just weird.

I feel very lucky to have made it through my adolescence and young adulthood relatively unscathed, despite some very poor choices that I made along the way. I credit a few things for keeping me on the thin line between rebellion and disaster. My parents gave me a strong foundation of literacy very early on. They may have made some mistakes in other departments, but my love of reading really took hold and kept me at least partially invested in school. I was also in a magnet program throughout my public school education–where the prevailing attitude wasn’t “IF you go to college…” but “you WILL go to college”–and lo and behold, I wanted to go to college. In fact, I wanted to go to college so much that I made damn sure I was on birth control so I wouldn’t get pregnant and ruin my life when I started having sex, and I stopped doing drugs when I got worried that I might develop a habit. Partially, this is due to genetics. I was born pretty smart, and that helped. And I must not have the genetic predisposition for addiction, because certainly I had the opportunity to develop one. I am eternally thankful that I dodged that bullet. I guess it was luck, with a little hard work and some drive to succeed thrown in, that finally brought me to where I am today. And now I sit at work–my white coat covering tattoos, facial piercings long since removed, the ghost of my youthful self marveling at at this new specter of adulthood.

I remember you November 20, 2009

Paulina Ibarra
Location: East Hollywood, California
Cause of Death: Stabbed to death
Date of Death: August 28, 2009
Paulina was found dead inside her apartment, she had
been stabbed to death. Paulina was 24 years old.

Kamilla
Location: Volgograd, Russia
Cause of Death: shot to death
Date of Death: June, 2009
Was shot to death by her boyfriend Vladmir after he discovered
that she had been born male. Kamilla was 30 years old.

Jimmy McCollough
Location: Fayetteville, North Carolina
Cause of Death: his murdered body
was found on Joseph Street behind the old Club Spektrum
Date of Death: April 14, 2009
Jimmy was a drag performer whose performance name
was Image Devereux. Jimmy was 34 years old.

Cynthia Nicole
Location: Comayaguela, Honduras
Cause of Death: Shot 3 times in the chest and once in the head by three
unknown men driving a blue car in Barrio Guaserique, Comayaguela, near Tegucigalpa.
Date of Death: January 9, 2009
News sources believe that the killing of Cynthia Nicole may be related to her legitimate human rights activities, in particular her involvement in the defense of the rights of the transgender community.

There were 91 more reported deaths of trans people worldwide. And these are only the deaths that were reported.  I am praying for the day when no trans person has to live their last moments surrounded by hatred and cruelty.

Not the best way to get a promotion November 17, 2009

This morning I had a patient that combined several of the key ingredients for an annoying encounter. Forms that needed to be filled out TODAY? check. Chronic health condition that patient has not been proactive about treating? check. Non-specific mental illness that results in rambling, semi-coherent long monologues? check. Multiple requests for specialty referrals, medication refills and letter for parole officers? Check, check and check. To top it all off, after our 40-minute counseling session when I stood up to usher the patient out the door, he announced “Oh, I forgot to tell you that last week I lost control of my bowels for no reason and my back really hurts and my doctor said to say something if that every happens because it’s really important.” OH. MY. GOD. Are you serious? After all of this effort and time you’re going to make me work you up for cauda equina syndrome with 2 more patients waiting for me?

I asked him to wait a moment while I went into the next room. That room happened to be the staff office, where I announced to an attending physician: “I am filled with a murderous rage. A rage towards my patient. I kind of want to kill him right now.” Note to self: things that sound funny inside the brain sometimes sound crazy when spoken out loud. This may be one of those things. Maybe I won’t mention the “murderous rage” part next time.

Thursday is Haiku Day November 12, 2009

Trying to do work

Remote account–can’t log in

Angry…yet relieved.

Crazy man in hall

Patients gather to watch the show

Hello?  Privacy?

Stressed doctor mutters

“Should have chose different field”

Not having good day.

Furious like me November 10, 2009

Yesterday I saw a patient that is always angry about something.  You probably know the type.  The cholesterol medication “almost killed me” with its GI side effects.  The topical steroid cream “didn’t help this rash that is killing me.”  Her PCP “doesn’t help me” and usually “nobody here cares.”

During the visit we were discussing her lower extremity edema.  As I informed her (in Spanish) that I would be prescribing some furosemide for the swelling, she looked delighted and asked me to repeat the name of the medication.  “Furosemide?  Haha!  Furiosa, como mi! (it’s furious, like me!)”  Hey, at least she has a sense of humor about it.

Unfunny week November 6, 2009

It wasn’t the greatest of weeks in the life of Lesbonurse.

It started when I sent a patient to the ER, thinking that she had a critical but ultimately fixable problem. It turned out that she had metastasized pancreatic cancer–picked up as an incidental finding on the imaging study I had ordered. It’s nice that we found the cancer, but it wasn’t the glorious “good catch” moment that I was hoping for. It’s not really a good catch when you realize that your patient’s daughter is soon to be an orphan.

This depressing day was soon followed by the news that one of my immediate family members had been admitted to a psychiatric hospital. It’s remarkable how much stress this can cause for everyone else in the family. I spent a lot of time on the phone, talking to the hospitalized family member, then debriefing with other family members after their phone calls or visits.  Thank god I have a therapist!

Adding a kick while I was down, Maine voters rescinded gay marriage in their state. Nothing reminds you that people hate you for existing like people voting to take away your legal rights. Screw you, Maine. Screw you and your delicious lobster rolls.

 

Maybe next week will be better.

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)”