This week I saw 2 butch lesbians for their complete physicals, including paps. I have another genderqueer patient scheduled for a pap next week. This makes me pleased, because I feel like I can do a much better job than my colleagues (hey, just bein’ honest). However, I’m still working on the best way to do a sensitive but competent exam. I had one patient this week that was in her 20’s, had never had any sexual contact with a man and had never had penetrative sex. She was so nervous about the exam that she was shaking and terrified. To make her feel less exposed, I told her she could leave her sports bra and tank top on during the breast exam, and I just lifted up her clothes one side at a time to do it. This seemed to make her feel better, so I told my next butch patient that she could also leave her bra on under her gown. But I have a question for any of you blog readers that have experience with clinical breast exams: do you think this compromises the exam? I understand that having a bra on does reduce the ability to visualize the entire breast area, but do you think it reduce the efficacy of the palpation? And if it does make the exam less reliable, do you think that the decrease in reliability is significant enough that I should make all patients take off their clothes, regardless of how uncomfortable it makes them?
More healthcare haiku June 17, 2008
Dry cough for four months.
Wee guatemalan lady,
Do you have TB?
Not a heart attack!
Looked at my schedule:
Creepy guy back tomorrow–
Time to call in sick??
Meltiiiiiing… June 10, 2008
Those of you who live on the East Coast are feeling what I’m feeling right now…which is fatigue and a heat rash. It is stunningly, horribly and stickily hot. On the up side, almost all of my patients canceled their appointments so they could melt in their homes. On the down side, I got almost nothing done, despite my hours of free time spent at my desk. You see, over the weekend the cooling unit of our large building had some kind of a breakdown, and no one knew about it until the staff started to come in this morning. That was when we discovered that the ambient air temperature inside was only slightly lower than the outside temp of 100 degrees. Though I had planned ahead by wearing a sleeveless dress, the warm moist air seemed to sap any sliver of motivation that I had. At the end of the day, I had seen a grand total of 4 patients, completed 6 progress notes from last Friday, and spent an excessive amount of time reading about seborrheic dermatitis on the internet. Oh, and I spent about an hour chatting with various clinic personnel. Yep, this is why they pay me the big bucks.
Friday Morning Haiku June 6, 2008
It’s raining outside-
Can’t take the dogs for a walk.
Rash in your armpits:
Got to stop shaving!
Better now that you’ve cut down
from three packs a day
I saw a depressed patient today. So depressed, in fact, that he tried to kill himself the other night. How did he do it, you ask? He tried to overdose on his own insulin. But what happened? His blood sugar was so high that the 80 units of insulin he gave himself didn’t even make him feel dizzy! He said that after the “overdose” of insulin he even felt a little bit better than before! Unfortunately, did not get out his glucometer and therefore has no record of what his sugars looked like around this time. I imagine for a few hours there they might have looked normal.
Quick, someone give me a medal–I tried hard to be a gay hero today. I started the day by giving some of my conference materials to the cute young butch in the admin department, then inviting her to come spectate at a women’s softball game with me sometime (just being friendly, people! She knows my gf is on the team). I then approached one of the attending physicians with a conference update and the idea to do a Grand Rounds on trans health. This turned out to be a much slower process than I had hoped (the projected date of trans health Grand Rounds is spring of 2009) but my colleague was enthusiastic about trying to make it happen. Then this afternoon I saw a suspiciously gay-looking woman and her female friend for a blood pressure follow-up. While I normally content myself with being extra-super-accepting and trying to give the “Me, too!” eye while still appearing professional, I wondered if I could do more. Suddenly it occurred to me: I haven’t been encouraging my same-sex partnered patients to fill out health care proxy forms for each other. Given the general crapulence of my city, it seems prudent for the gays to have some legal protection in case of hospitalization. After a garbled attempt at explaining in Spanish the importance of health care proxy for LGBTQ patients, I shoved a form at my bemused-looking patient and advised her to look it over at home. I then vowed to myself to do this for every queer couple (or patient) that I have. Whew, what a gay day!
The healing power of roadtrips June 1, 2008
After lunch with a friend in NYC, a power nap and then 3 hours of driving and singing out loud to myself, I’m now home and feeling more upbeat about life in general. Long solo car trips that involve singing tend to make me feel cheery.
I know in my last post I emphasized the depressing isolation that I felt on the first day of the conference, but I actually feel really good about the last couple of days. I got to meet awesome providers, visit with old friends and eat food prepared by Mennonites at Redding Terminal Market–what could be bad about that?
One of the coolest things about the conference for me was the presence of transgender children and their families. There were lots of kids there, both children of trans parents and children who were trans themselves. In my last moment in the hotel, I rode the elevator down to the lobby with a little boy and his family. He was wearing a little baseball hat, stripey shirt, adorable little-kid glasses and a sticker that said “God made me trans.” How cool is that?