The magical mystery land of community health

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

Sunday night haiku June 29, 2009

Filed under: Uncategorized — lesbonurse @ 2:41 am

Some days it is hard

working with mentally ill

patients all day long.

Yes, you have swine flu

Now please, put on a damn mask!

Stop coughing on me.

Office full of treats

Total weight gain: twenty pounds

Lesson? Bring own snacks


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Your dog does what? June 23, 2009

Filed under: Uncategorized — lesbonurse @ 1:01 am

Today I had a patient who came in for her pap.  She appeared to be very, very high.  A major tip-off was the fact that she nodded off 3 times during the interview part of the visit.  Despite this, I decided to go ahead with the pap.  I figured she probably had a difficult time getting to the clinic, so we might as well capitalize on the time that we had together.  During the pap, she (unsurprisingly) nodded off again.  What was surprising was what happened when she woke up:

Patient: “Wha?”  (wakes up and starts kicking my arm as I am doing her pap)

Me: “Don’t kick me!”

Patient, slurring speech: “Ohhh, I thought it was the dog.”  (mumbling unintelligibly, nods off again)

Me: “Nope!  Just finishing your pap!”

So I had just one lingering question…whose dog sneaks up on them and inserts a speculum while they sleep?!

 

I think I know what the problem is… June 19, 2009

Filed under: Uncategorized — lesbonurse @ 1:28 am

Patient: I’m so tired all the time. I just feel so lazy, like I don’t want to do anything. All I want to do is sleep. I could sleep all day.

Me: How many hours do you sleep a night?

Patient: About 7

Me: Tell me about what you do before you go to bed.

Patient: Well, I smoke a joint before bed. Then I lay down and go to sleep.

Me: Do you smoke every night before bed?

Patient: Sure do. I smoke all day long.

Me: Like how many times a day?

Patient: Like 3 or 4.

Me: 3 or 4 times every day?

Patient: Yep.

Me: Well, that’s probably causing your lazy feeling. Being tired and unmotivated is a side effect of marijuana use.

Patient: I don’t think so. Maybe I have diabetes.

Me: Well, that could be true too, but I think the marijuana is playing a part.

Patient (doubtfully): maybe…

 

Awards time! June 17, 2009

Filed under: Uncategorized — lesbonurse @ 11:48 pm

Winner for “Best Muddling of a Brand Name”:

Patient: I need some of those clozenges.

Me: What? Klonopin?

Patient: No, Clozanges.

Me: Clozaril? Clonidine?

Patient: No, CLOZENGES. Those pill things to stop smoking.

Me: OH. You mean the Commit Lozenges that I prescribed you?

Patient: Yeah, those. Clozenges.

Sentences That Best Illustrate How a Sensitive Health Care Provider Gets Jaded:

Me, to NP student, regarding a patient who was beaten by her boyfriend: “Ok, make sure you document the location of all of her bruises in case she presses charges. And document that we counseled her about how domestic violences escalates over time. If he comes back and kills her, we want people to know that we at least tried to address it.”

Student: “Right.”
Me: “Of course, if he kills her that would really suck.”

Student: “Right”

Me: “Ok then. Got to go on to the next patient. Ready?”

Worst mistake that Lesbonurse has ever made:

Doing an outpatient I&D and starting oral antibiotics on a patient with an abscess that turned out to be necrotizing fasciitis.

Worst mistake that Lesbonurse has made this week:
Miscalculating the Framingham Risk Score and starting the patient on a statin that she didn’t need.

Most challenging patient of the day:

Man who is completely unable to read or write, with some kind of mental illness PLUS insulin-dependent diabetes

Best description of laziness, as described by a patient:
“Oh, her? She wakes up just to go back to bed!”

 

A dose of brotherly love June 15, 2009

Filed under: Uncategorized — lesbonurse @ 1:40 am

I just returned from the annual Trans Health Conference in Philly. Last year I spent a good portion of the conference feeling verklempt about my lonely practice as an isolated, relatively inexperienced, tranny-loving NP. This year I felt better. A few things have changed over the past year: I have more trans patients, I’ve made some headway with management (they’ve progressed from “I don’t care at all about this topic” to “Perhaps Lesbonurse is not crazy, maybe we can get some more patients out of this…let’s give it a go”), and I’ve made a few professional contacts in my community. Overall, I feel good about my work–I still feel inexperienced, but I guess that feeling sticks around for a few years. I met some rockin’ NPs and nursing students at the conference. It’s good to know that other folks are fighting The Man in their own respective corners of the world. And I got to see one of my favorite doctors, Maddie Deutsch, who manages to combine trans-affirming medicine, progressive politics and feminism with a punk rock, bicycle-riding aesthetic–that’s not easy! I also got to listen to presentations from other super-knowledgeable providers. I try to soak up as much knowledge as I can to make up for the lack of any relevant material in my journals and textbooks. It’s also great to sit in on the “community sessions” and hear directly from community members about their concerns.

I took a break from the conference to hit the Mutter Museum. For a dorky gal who loves a good preserved organ in a jar, this is the perfect museum! It is gross, yet riveting. I took away 2 main lessons: 1. Do not get Syphillis. And if you do, treat it quick! There are many, many disgusting things that can happen to you if you have tertiary syphillis (these things are displayed on chillingly realistic wax models). 2. I hope to avoid both “toxic megacolon” and huge–REALLY huge–ovarian cysts. Both of these things are on display and are icky!

 

The exam room trinity… June 8, 2009

Filed under: Uncategorized — lesbonurse @ 2:21 am

…me, the patient and God. Or Jesus. Or sometimes, God and Jesus in the same sentence. I talk about a lot of things with my patients: sex, drugs, feces, crime, child abuse and violence. But what do I really hate? Getting into conversations with well-meaning patients about the state of my soul.

I grew up with a bible-thumping, fire-and-brimstone-lovin’ extended family. My parents’ Judaism was a constant source of worry for my relatives, as they fretted about our eternal souls burning in a lake of fire forever. And when I got into my rebellious, pro-choice, feminist-in-training high school years…oh dear. As a teenager, I thought it was fun to argue with them. I even entertained the idea that my brilliant teenage perspective might get them to see the close-minded hurtfulness of their ways. But after a while, I realized that I might as well save my breath for something more plausible, like writing an Oscar-winning screenplay or eradicating poverty. It wasn’t until I was well into adulthood that I accepted Christianity as an important source of support and strength for people (prior to that I thought of it solely as a battering ram, poised to smack me down for being naughty).

I do appreciate when patients wish me a blessed day, or pray for my good health and happiness. I don’t mind if patients want to tell me about their personal experience with Jesus, or how the church helped them out of addiction or crime. But please…don’t ask me if I’ve accepted Jesus into my heart. I haven’t. And I don’t plan to.  But I don’t want to tell that to patients because I feel like it would drive a wedge into our therapeutic relationship. I try to dodge questions, sometimes with pleasantries (“Oh, I’m so glad you found a church that you like so much”) and sometimes with direct limit-setting (“Sorry, I don’t discuss religion”). The other day a patient came in with Chick pamphlets and was handing them out to the staff. Ack! Chick pamphlets, the publications that I found so hilarious in high school. Chick pamphlets, which among other things have asserted that the gays want to give AIDS to heterosexuals, that Catholics and Muslims go straight to hell, and that rock n’ roll music is a one-way ticket to a sulfurous lake of fire. For the duration of our visit, the patient had the little pamphlets fanned out on the desk. I tried not to look at them, for fear that she would try to engage me in a conversation about the truths hidden in their tiny, comic-book pages.

Another patient last week told me at great length about how God was the only way to true health. Unfortunately, this patient has diabetes, so unless God’s other name is “Humalog,” God has a co-star named Insulin. Although spiritual counsel isn’t my strong suit, I tried to affirm his faith while discouraging his idea that God will work a miracle to restore his pancreas to its original glory. I have a little stock response that I use: “Do you think that God created your doctors and nurses? And that maybe God put us here to help you out? And do you think that God wants you to be healthy?” It’s hard to argue with that rationale. Or at least, I hope it is.

 

Ask the question June 3, 2009

Filed under: Uncategorized — lesbonurse @ 1:35 am

Today I performed a physical exam on a new patient. He appeared to be an average man in his 60’s. We went through the Review of Systems, then moved on to Social History. In addition to the smoking and drinking questions, I try to ask all of my patients about their sexual history. I don’t need to know the exact number of partners that you’ve had in your life, nor do I need to know your favorite sexual position. I do need to know whether or not you sleep with men or women, whether you are sexually active now (or in the recent past), whether you’ve had multiple partners and what kind of pregnancy or STD prevention you use.

I was going through my usual routine when I said, “I ask everyone this question: do you sleep with men, women or both?” My patient, looking a little taken aback, said “Men.” I’ll admit, even I–Lesbonurse!–was a little surprised. He just didn’t look gay (whatever that means). But I forged ahead with my next question: “How often do you use condoms when you have sex? Some of the time? All the time? Barely ever?” My patient stopped me by looking me in the eyes and saying “No one has ever asked me that before.” “Oh,” I said, preparing to move on. “No,” he said, “I mean, no doctor has ever asked me that before.” I dropped the social history questions for a little while, and we talked about his experience as an older, closeted gay man. The experience was a good reminder that even me, a super-gay healthcare provider, makes assumptions. And even me, super-gay healthcare provider, needs to ask the question every time. You never know.