The magical mystery land of community health

I don't make this stuff up!…but I do change identifying information.

Days that make you go ‘bleh’ February 28, 2008

Filed under: Uncategorized — lesbonurse @ 2:21 am

Today was a day rife with the challenges of community nursing. Here are a few highlights of my day:

  • Was shadowed by a nursing student from local community college for entire morning
  • First patient of the day was a woman whose recent MRI confirmed a tumor. Though cancer had been discussed as a possibility at other visits, the patient had not yet received her MRI results
  • Second patient of the day had a cough and body aches for 2 days, and was very upset that there was no magic cure. Welcome to Virus-town, lady. Population: You and the entire rest of the community. There’s something going around.
  • Realized I started a patient on a beta-blocker without noticing her history of mild asthma. whoops.
  • Old man with gout complained bitterly about the pain of his gout attack and then complained equally bitterly about the dietary changes that I suggested. Yes, old man, you need to throw out that fresh liver you have in your fridge. No, you cannot continue to eat liver and bacon and “just take my gout pills the next day to stop the attack.”
  • At the end of the day, had a pounding headache from the florescent lights and was completely drained of compassion and kindness
 

It’s lonely at the top February 25, 2008

Filed under: Uncategorized — lesbonurse @ 12:40 am

This week was slow. Many of my patients do not have cars, so when it starts to snow, people just don’t come to their appointments. Our clinic has a general no-show rate of about 30%, but last week i had a few days with a no-show rate of approximately 70%. This enabled me to have long, tedious nursing interventions with every lucky patient who showed up on my schedule. Additionally, I am completely caught up on all of my charting, labs and patient phone calls.

Due to the weather, I don’t have any interesting stories from my last week at work. However, the extra time that I spent wandering aimlessly throughout the clinic led me to ponder my sad lack of real connections with my colleagues, particularly the medical assistants. Of all the groups at the clinic, I feel the most affiliation with the ma’s. The residents are too busy (and frankly, too boring) to cultivate friendships with. The nurses are friendly enough, but we don’t have much in common, and they seem to feel the gap between my role and theirs. The ma’s are the group I’ve always seen myself in: struggling to get by on crappy wages, snickering at the doctors behind their backs, joking and laughing to get through the day. But I’m not part of that group anymore. Instead I share an office with an older NP who is so sunny and sweet she could be June Cleaver, and another NP who has a wee baby and therefore is rightfully preoccupied with her life outside the clinic.

This comradeship gap is something I’ve been thinking about for a while, but something happened last week that made it painfully obvious. I have always assumed that my coworkers see me pretty much the same as I see myself: a young(ish), sarcastic, funny and reasonably cool person. However, it seems that my coworkers see me as an 30-something, white, upper-class woman who is completely out of touch with the youth of today. Why do I think this? Because one of the medical assistants (in fact, my favorite medical assistant) asked me if I know who Beyonce is. Excuse me? Do I not have a tv AND a radio? And eyes?

While my memories of being a medical assistant are as clear as day–or more accurately, as clear as the urine samples I used to process–I know that my coworkers don’t have a good idea of my history. They think I’m just another highly educated white person who commutes to work every day and eats her organic snacks in the break room (all true). How would they know that I went to a high school where students got stabbed in the halls? And how would they know that I used to live on an annual salary of $19,000 a year before I was a nurse? And even if they did know, they would probably also know that my experience is still not the same as theirs. I had a college degree when I was working as a medical assistant. I was just biding my time until I figured out how to take that next step into a higher tax bracket. And I don’t have any children–which, at 30, makes me somewhat of an anomaly in my clinic. Without children, I got to keep that whole $19,000 a year for myself, instead of having to spend it on diapers and formula. And now I own my own tiny little house in a “good” neighborhood, drive my own car and wear slacks instead of scrub pants. No wonder people think I’m too good to listen to Beyonce on the radio!

It’s a weird place to be, this professional island. I don’t feel like I’m on equal footing with anyone.

 

concrete countertop, i love you February 20, 2008

Filed under: Uncategorized — lesbonurse @ 12:41 am

Yay! Today we got our new concrete countertop installed. No more old rotting wood countertop resting on our new cabinets! Concrete is so cool.

counter

counter

 

Capgras delusion February 17, 2008

Filed under: Uncategorized — lesbonurse @ 7:57 pm

On Friday I had a patient with a history of schizophrenia and Capgras Delusion, which I found fascinating and sad at the same time. For those of you who may not know what Capgras Delusion is (I didn’t), it is the belief that someone close to you has been replaced by an identical impostor. For the patient with Capgras Delusion, the impostor looks and acts exactly the same, but only the patient knows that they are actually a stranger instead of their loved one. Apparently, this belief in the identical impostor can apply to pets or household items as well. And it affects not only people with schizophrenia, but also people who have had a traumatic brain injury. I can only imagine that it must be really, really freaky to wake up one day and think that the person who looks and acts like your spouse is actually a stranger.

 

The game of telephone February 16, 2008

Filed under: Uncategorized — lesbonurse @ 12:09 am

I am continually boggled between what I recall saying to my patients and what they remember. Now, I am a person who tries to be conscious about using easy-to-understand language. I try to explain any big words that I use, and not give abnormal lab results in scientific language. Lately I have been pondering the seemingly insurmountable task of effectively educating the patients. Here are some recent statements from patients that left me thinking “Hmmm, they don’t really get it, do they?”:

  • “The doctor told me the medicine (hydrochlorothiazide) was for my cholesterol! He said it would make me pee more and then I would pee out all of my cholesterol.”–from a man who was incredulous that HCTZ was in fact for blood pressure
  • “So…the crack cured my diabetes?” –from a formerly obese woman who lost 150 lbs due to a crack addiction. The crack also cured her high cholesterol and high blood pressure, apparently.
  • “Do you think the crack cured my abnormal pap, too?”–the same woman, shortly after being told that the crack had not actually cured her diabetes
  • “The stomach test was abnormal.”–This statement was made to a GI specialist a mere 3 days after I had a long conversation about the patient’s gastric motility study that involved the words “Your test was normal. Yes, it was really normal.”
  • “The last lady who did my pap smear said that I have an extra hole in my vagina.”–from a woman who had a polyp protruding from her cervical os (incidentally, the woman no-showed for her GYN consult 2 years ago to follow up on this)
  • “The doctor at the emergency room told me to take 800mg of ibuprofen every 3 hours, and 400mg whenever I needed it if I still had pain.”–This statement, by a 68 year-old woman, was immediately followed by my recommendation to have some kidney function tests done.
  • “I thought I was taking the antibiotics that you gave me, but I was actually taking my pain pills that I had in the cabinet!  Ha ha!  I just figured it out this morning!”–from a patient that I was seeing for a 7-day follow up for cellulitis

I have been trying to write my instructions down, and have even gone so far as to draw illustrations for my patients who can’t read.  I feel like I’m carrying on a proud NP tradition of patient-centered care, but I’m not really sure if it is having any beneficial effects.  sigh.  At least it’s funny.

 

not too late to send a VD card February 15, 2008

Filed under: Uncategorized — lesbonurse @ 2:18 am

www.vd.meish.org

I like the “heartpuke” card.

I got my lady love a block of fancy Irish cheddar cheese. Because I am just that romantic.

*hmm, i can’t make the link work.  it seems to work if i cut and paste it into the address bar.  damn.

 

a little haiku to start the week off right February 11, 2008

Filed under: Uncategorized — lesbonurse @ 2:32 am

This season’s illness

Sore throat, sniffles and fatigue

No, I can’t fix it

A terrible sight

Homeless man with frostbite

It smells disgusting

Your diabetes:

How do I explain to you

This is not a joke