The magical mystery land of community health

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

25 Things January 29, 2009

Filed under: Uncategorized — lesbonurse @ 3:42 am

I keep getting these “25 Things About Me” posts from everyone and their mother.  It does tap into a certain narcissistic vein, doesn’t it?  In fact, I can’t resist doing it right now.  I’ll try to keep it healthcare themed.  And I won’t tag people…mostly because I don’t really know how to tag people via a blog.

  1. My earliest career aspiration was to be a stand up comic.  Then I wanted to be a doctor.  Then, after a series of disappointing “aha! moments” that are too long to get into here, I decided that Nurse Practitioner was the way to go.
  2. I am really grossed out by injuries involving the eyes.  Also the teeth.
  3. I wanted to think childbirth was beautiful, mystical and amazing…until I witnessed a birth and found it unsettling, a little scary and with much too much perineum stretching for my taste.
  4. Despite my lack of love for the glory of birth, I am an ardent feminist.
  5. I fear that I am going to develop Type 2 diabetes, thanks to an abundant supply of visceral fat.
  6. I love counseling young women about their reproductive system.  Today I had a great conversation with a 21-year old about why she was experiencing vaginal dryness during sex (here’s a hint…F-O-R-E-P-L-A-Y).
  7. I love kids and am in preliminary talks with my significant other about having a baby.  Just preliminary, folks!  No basal body temp charting yet.
  8. I have a National Health Service Corps contract and–so far–am not burned out on my job, nor do I regret it.
  9. Assisting in abortion procedures was one of the most intense jobs I have ever had.  And I had the most intimate connections with patients that I’ve ever had.  I never regretted that job, either.
  10. I hate winter
  11. I hate vegetables, despite my daily sermons to patients extolling their virtues.
  12. I love coffee.  Sugary sweet coffee drinks with caramel sauce, I love you the most!
  13. I’m agnostic.  I have a hard time believing in a god that allows random violence and inhumanity.  But I also have a hard time believing that there’s nothing out there beyond our comprehension.
  14. I am not a fan of little dogs.
  15. I’ve never smoked a cigarette.
  16. I grew up in a city where everyone was tan…but I’ve always been a fan of sunscreen.
  17. I believe that hospice is woefully underutilized.
  18. Sometimes I think about going into palliative care.
  19. I’m a little afraid of taking care of old people.  Their fragile skin kind of freaks me out and I’m constantly afraid that I’m going to overlook some symptom of fatal illness.
  20. I love “Trauma: Life in the ER” and I think I’ve seen all of the episodes at this point.
  21. Although I don’t want my patients to be sick, I’m sometimes a little disappointed when the expensive tests that I order don’t come back with interesting results.
  22. I’ve found that primary genital herpes lesions never look as convincing as they do in the textbook.  Why must they resemble cellulitis or folliculitis?
  23. Years ago, I used Xanax for anxiety and it worked wonderfully.  No wonder folks get addicted to the stuff!
  24. I still can’t tell what I’m looking at during a fundoscopic exam.  It’s my shameful secret.
  25. I still can’t hear a grade II heart murmur (and sometimes I can’t hear a grade III, either).
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Another edition of the Totally Inappropriate Comment January 26, 2009

Filed under: Uncategorized — lesbonurse @ 2:03 am

Sunday night means grocery shopping, The Simpsons…and reflecting on last week’s Totally Inappropriate Comments:

  • Patient with a UTI: “Um, can I ask you a question? Do you think my bladder infection is because I had anal sex with my boyfriend and then he took it from the back and put it into my…you know…vagina…again?” Actual comment: “Did he shower and wash with soap before he put his penis back in your vagina? No? Then yes, that is why you have a urinary tract infection.” Totally Inappropriate Comment: “DUH. And also…EWW.”
  • Patient with asthma exacerbation: “Yes, I’m using my inhalers every day.” Actual comment: “Hmm, well I see that this Flovent inhaler expired over a year ago. Are you sure you haven’t been missing any doses?” TIC: “Admit it! You haven’t used this inhaler in years! Gotcha!!”
  • 65 year-old patient who had only seen a doctor once in the past 10 years: “I just felt fine, so I didn’t come to the doctor.” Actual comment: “Well, I’m glad you came back. Your blood pressure is really high and that fingerstick we just did shows that your sugar is really high, too.” TIC: “Seriously, you’re about to stroke out from your hypertension. Your blood sugar is 299 and that’s just on our office glucometer. Wait until we get your HgbA1c back!” (FYI, the HgbA1c was 13)
  • Me, to a patient who had previously claimed he had no notable medical history: “I checked the computer, and I saw that you were seen 10 years ago by a surgeon for the removal of a cancerous tumor. Do you remember that?” Patient: “Oh yeah, I did have surgery.” Me: “Did anybody tell you that the tumor had cancerous cells?” Patient: “Oh, yeah, I think they told me.” Me: “Did you ever have any follow up on that?” Patient: “No.” Actual comment: “Well, I’m going to call the surgeon’s office and see what we need to do to make sure that tumor didn’t come back.” TIC: “Really?? You had cancer and you never even went back for your post-op visit? It doesn’t bother you that you could have an easily detectable and treatable cancer that could now be metastasized to your entire body?”
 

Monday haiku January 13, 2009

Filed under: Uncategorized — lesbonurse @ 3:01 am

Freezing cold weather.

Somehow, my patients still manage

to walk to clinic

Acute low back pain:

Self-trial of Lidoderm patch

Hey, it really works!

Never seen before:

Hemoglobin A1c

over seventeen!!


 

Adventures in automation January 7, 2009

Filed under: Uncategorized — lesbonurse @ 2:49 am

I’m participating in a little office experiment called “Trying Out Voice Recognition Software.”  So far it’s going…slowly.  This is what it’s like:

Me (dictating into microphone): “The patient complained of pain in her right hip.”
Voice recognition software, writing: “The passion corn planted  plane in the rye hop.”

Me: “Wait, wait.”

Software: “Whey, white.”

Me (covering microphone): “Dammit!”

Software: “dam hit”

Me, slowly: “The PAYYYYSHENT comPLAYYYned of PAYYYNNN in the RIIIGHHT HHHip”

Software: “The patient complained of pain in the right hip.”

Me, muttering: “I’m just going to type now.”

Software: “Aim just going to tap down”

Me: “dammit!”

 

Don’t say this out loud January 3, 2009

Filed under: Uncategorized — lesbonurse @ 4:57 am

Things you should avoid saying to your 30-week pregnant friend:

  • “Oh my god, you’re wearing…a poncho!  Wow, what a poncho!  Ha!”  (friend will say “It’s a shawl.” and then go into the other room and say “Lesbonurse hates my shawl!”)
  • While feeling the baby kick: “Whoa, how weird!  It feels like an alien in there!”  (Friend will look less than amused.  Bystanders will look confused at lack of appreciation for the beauty of pregnancy)
 

Don’t speak too soon January 2, 2009

Filed under: Uncategorized — lesbonurse @ 5:17 am

Two weeks ago I was having a talk with a local provider who treats transgender patients. She was telling me about some of her more challenging cases, including a young patient who had been unable to get a letter approving him for hormones from his therapist, in part due to his age. She asked me what I thought, and my response was “Well, I haven’t had to make any judgment calls like that yet. All of my patients have been older and firmly established in their gender identity. Most of them have already been on hormones at some point in their lives.” As an old housemate of mine likes to say: If you want to hear God laugh, make a plan. Less than a week later, I received a phone call from a barely-over-the-age-of-consent young adult who’s looking for someone to start them on hormones. The patient sounds like they have it together, but also sounds very young. They have already seen an endocrinologist in this state, who declined to start hormones (it sounds like it was due to age, but I’m not sure if there’s more to the story).

I’m not opposed to people starting a gender transition in adolescence, if it’s a thoughtful decision made with professional support. I’m not opposed to people wanting to modify their bodies to fit their gender identity, even if they don’t fit into the gender binary mold. Generally speaking, I’m pretty fucking progressive on this topic. But part of me instinctively thinks “Gosh, adolescence. That’s pretty young to make decisions about permanently altering your body.” I guess the answer is: it is, and it isn’t. I know people who have transitioned later in life, and would have been fully capable (and happier) to make that decision earlier. I know that for someone who has spent years, or even a lifetime, feeling that their body doesn’t match their mind, no time is soon enough to start changing. And I know a few people who transitioned in their early 20’s, and then later decided that they really wanted to live as their original gender and transitioned back (un-transitioned?). I guess what makes me nervous is the patient’s youthful excitement and exuberance. Yes, it is exciting. Yes, I understand that often patients are dying to get the transition process underway as quickly as possible. But even if it’s exactly what the patient wants, it’s still a big deal. Sometimes a really big deal.

Some readers are probably wondering if I have a plan for this patient. The answer is yes. I want to know more about their gender identity, and the history of their identity. I want to talk to their therapist. I want to talk to the patient and find out what they think is going to happen when they start hormones. I want to find out if they’ve come out as trans to their family, friends or school. I’d like to know what kind of support they have. And I don’t plan to give them hormones on the first visit. Maybe the second, or the third, but I’d really like to do a good assessment first. We’ll see how it goes.