The magical mystery land of community health

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

Damn The Man August 27, 2008

Filed under: Uncategorized — lesbonurse @ 1:20 am

It’s probably obvious to readers of this blog that I’m a feminist. It’s sort of funny how stereotypical I am: a queer women’s studies major who worked in family planning and now works in community health, trying her damndest to make the world a more just and liberal place. The only things missing are the flowing hippy pants and the Teva shoes. Occasionally I have a feminist meltdown at work.

One such meltdown happened the other day when one of our caseworkers told me about a doctor who refused to give a patient emergency contraception. This particular patient is a single parent with medical problems.  She showed up to the clinic 14 days ago, stating that she had sex with her partner and wanted emergency contraception. She had used a condom, but was afraid that it might have broken. Hmm…a single parent, terrified that she might get pregnant again despite the use of a condom? A Plan B rx sounds perfect, right?? Wrong.

The resident asked the attending about the prescription. According to the caseworker (who was there because she works with the patient), the words “abortion pill” were bandied about during the case presentation. Seriously people, how long has Plan B been available? It’s not a fucking abortion pill! Mifepristone is the abortion pill! The attending physician went in to talk to the patient, and asked her things like “Did you see him put the condom on the erect penis?” and “Was there ejaculate inside the condom when he was done?” (hello…gross and awkward?) THEN the physician told the patient that he wasn’t going to give her Plan B “because you aren’t going to get pregnant because you used a condom”(!) He also gave her some other misinformation, telling her that Plan B would make her terribly nauseous and sick and that she shouldn’t use it unless it was “really necessary.” Here’s my position: If a woman thinks she’s at risk of getting pregnant, it’s necessary. Plan B is so safe that it’s available over the counter and almost any woman can take it! Studies have shown that it doesn’t affect women’s risk-taking behavior! It doesn’t affect an already implanted pregnancy! What the hell more could you want out of a medication?

The patient was sent on her way with a baseline pregnancy test and advised to come back to see me in 2 weeks for repeat pregnancy test results. Ha–this is where I get to flex my prescriptive powers! The patient came in to see me today and left the clinic with a rx for Plan B (with 2 refills) and advice to fill the Plan B script in advance so that she doesn’t have to call and talk to her jackass of a PCP if it ever happens again. Damn you, The Man!

 

Sometimes it’s just not funny August 21, 2008

Filed under: Uncategorized — lesbonurse @ 1:19 am

Humor is my coping mechanism (and sometimes my crutch). I like to be funny, and I like blogs that are funny. So it’s kind of been a bummer that my last 2 weeks of work have been so depressingly unfunny. I mean, I’ll make fun of some pretty crappy situations. But here are some issues that I won’t make fun of: physical abuse of people with mental retardation, sexual assault, domestic violence, genuine suicidal ideation, the anguish of an illiterate mother who signed her parental rights away because she couldn’t read the DSS forms, and sexual abuse of children. All of these issues have been addressed by me during the last 2 weeks. Uplifting, right? No wonder I’ve been coming home feeling like a dumptruck full of grief ran me over.

 

Back-to-work Haiku August 18, 2008

Filed under: Uncategorized — lesbonurse @ 1:01 am

Daily two hour nap,

Nightly toasted marshmallows,

I love vacation!

Skin so damn itchy!

Covered with mosquito bites.

Do I have West Nile?

Semi-curious

About the new messages

Waiting on my desk

 

Adios for now, clinic! August 9, 2008

Filed under: Uncategorized — lesbonurse @ 12:13 am

Today was my last day of work before my glorious week of vacation. Yep, the past week spent waking up at 5:45 a.m. every day to frantically chart for that extra hour is paying off! I walked out of the clinic today at 5:30p.m. with no charts or paperwork on my desk and even my messy pile of paper clips neatly corraled. I am soooo looking forward to a break!

As final pre-vacation days go, it was pretty good. I saw two patients with unusual and interesting genetic syndromes.  I had a patient with a negative polio titer, which begs the interesting question(s): Does he need a polio booster? And if so, where do I get an adult polio booster? ‘Cause the hospital pharmacy sure didn’t have it in stock. And I got a phone call from a local transgender activist, telling me that he can refer some new patients to my clinic. So overall…a good day.

 

Get thee to an ER! August 4, 2008

Filed under: Uncategorized — lesbonurse @ 11:09 am

It’s amazing to me how there are 2 wildly different patient groups: the patients who refuse to go to the hospital, tell you “I don’t like to take pills” when their blood pressure is 200/120 and their sugar is 495…and the other group of patients who come to the clinic after 1 day of a runny nose and ask you for sleeping pills, percocet and a pill “to help me lose weight.” Of course, there is a third group of patients who basically do what needs to be done to stay reasonably healthy, but they’re not as funny to write about. Recently I’ve had a run of people who really should have gone to the ER, but didn’t, including:

  • Patient who suddenly started bleeding heavily from the rectum “like I was giving birth through my butt.”
  • Patient with COPD who has been waking up choking, bluish and gasping for breath since he got an upper respiratory infection a week ago
  • Patient with a chronic heart condition, who has been having episodes that involve collapsing to the ground, unable to move or speak
  • Patient who had been discharged from the hospital one day earlier, who apparently passed out and was carried to her bed by family members where she remained unconscious for 12 hours.

I’ve been working on my therapeutic intervention for this situation. How do I get the message across without actually saying to the patient “Look, this is when you’re supposed to call a freakin’ ambulance!” I’ve been asking people, “After this happened, did you or your family think about going to the emergency room?” Usually people say “Yes, but…” with reasons such as the wait time is too long, they didn’t want to be admitted to the hospital, or they didn’t think the issue was a big deal. I then follow up with something like “If this happens again, you really need to get help right away at the hospital.” Note to self, readers: sudden, continuous heavy bleeding from the rectum should be evaluated at a hospital, not in your doctor’s office 2 days later.