The magical mystery land of community health

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

Good News and Bad News: A Haiku September 29, 2009

Filed under: Uncategorized — lesbonurse @ 1:02 pm

Today’s good and bad:

Good: new pair of dansko clogs

Bad: Diarrhea

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The tip-off September 28, 2009

Filed under: Uncategorized — lesbonurse @ 11:28 pm

For my fellow health care providers who are just starting out in the field…here’s a little guide to what people really mean when they make these statements:

  • Patient: “No, that morphine didn’t help my pain.  That oxycodone doesn’t work at all.  The only thing that works is…gosh, I can’t remember the name.  Perk…Perk…oh geez, I don’t know.  It’s something they gave me in the ER…percocet?”   Actual meaning: drug-seeking
  • Patient: “I was carrying my bottle of MS Contin in my purse and then someone robbed me!  They stole my purse and my entire month of pills!”  Actual meaning: drug seeking
  • Patient: “I use my inhalers every day.”  Me: “Well, both of them are expired and they’re full of crumbs.  How did that happen?” Patient: “Well, I don’t know.  I use them every day.”  Actual meaning: I haven’t used those inhalers since 2007!
  • Patient: “I’m using my insulin every day”  Me: “Hmm, your blood sugar is 400 today…which is the same as it was before we put you on insulin.”  Patient: “It’s not working!”  Actual meaning: I hate the idea of insulin and I’ve never actually used it at home
  • Patient, in response to domestic violence screening: “Oh, my husband is a little jealous.  You know, possessive.”  Actual meaning: my husband is abusive and I’ve been completely isolated from my friends and support network
  • Patient, in response to the question ‘How come you decided to stop your medication?’: “God will decide if I live or die.  Solomente Dios sabe.”  Actual meaning: I’m not convinced that what you’re telling me is true.  Why should I follow your advice?
  • Patient: “I don’t like to take pills.  I’m not going to take them.”  Actual meaning: That about sums it up.
 

Two years of community health craziness September 23, 2009

Filed under: Uncategorized — lesbonurse @ 2:28 am

In the midst of a particularly busy month, the 2 year anniversary of my life as a NP passed quietly. Happy anniversary to me! It seems fitting that I spent the day doing several paps and several more new patient visits. What anniversary would be complete without a peek in the vagina followed by a long conversation about why narcotic pain meds aren’t recommended for 20 year olds with chronic back pain?

Actually, I feel pretty good about my career right now.  Yes, I am exhausted for 5 days a week.  Yes, I work 9 hours a day with a 25 minute lunch and then another hour every night at home (I can hear other nurses saying incredulously “wow, you get lunch?”).   But I’m proud of what I do.  I’m proud that I still make eye contact with people, still remember to ask about their kids and their pets and their church and their mamas and still manage to look like I care.  Actually, I do still care.  I’d like to think that I’ve learned to balance my caring with practicality.  Yes, it’s good to care about my patients.  But no, its not good for me to worry about them when I leave the office at night.  I do what I can during the day, and then I try to leave the rest behind until I walk back in the door the next morning.

I’m pretty proud of my work with LGBTQ patients.   I know they appreciate having a homo take their sexual history.  And I’m  proud of my work with the trans community.  I have almost 20 transgender patients now, and I’m getting referrals at the rate of 1 or 2 a month.  I’ve had meetings with management to talk about improving our care for trans patients.  I’ve spoken to other providers and helped to organize some local events.  And just recently one of the new first year interns mentioned that she would like to train with me during residency.  I’m thrilled that other providers are interested in this work.  I’m equally (if more selfishly) thrilled at the legitimacy that a resident training program would bring me.

I will say this: having transgender patients is extra work.  It’s not the patients themselves–they tend to be a little easier to work with than my ‘typical’ patients.  It’s the time spent being a conscientious provider that is ‘extra’.  I spend extra time on the phone because I handle all the prescription refills and patient intakes myself.  I spend a lot of time reviewing studies and hormone protocols since there’s no easy algorithm for care and I haven’t memorized all of the information yet.  I spend time contacting specialists prior to making referrals.  Since our electronic record system doesn’t let us enter a preferred name or gender, I walk around the clinic with a pen each time my patients come in and handwrite their preferred name on every label and piece of paper that is generated.  I’m not saying this just to piss and moan.  I like this work.  I like knowing that my patients are getting the best care possible from me.  I know that the care is not perfect.  But when I compare the clinic now to the clinic 2 years ago, we’re making progress.  The medical assistants have stepped up to the plate and do their best to treat the patients with respect.  The medical director has ‘transgender’ on his radar (which is progress compared to before).  The clinic social worker is going to attend a conference on trans health so she can better serve our patients.  The NP students I precept have expressed interest in the topic and have been excited to learn more.  And best of all…I have an interest and a passion that keeps me from getting bored and burnt out.  Seeing nothing but uncontrolled diabetes, hypertension and depression all-day-every-day would make me stab out my eyes.  Having a specialty interest keeps things feeling worthwhile.

So despite the kvetching and the whining about my job, I still like it.  Here’s hoping for another good 2 years!

 

Freudian slip September 16, 2009

Filed under: Uncategorized — lesbonurse @ 1:56 am

The patient: a man in his 60’s whose wife died last year. Reason for visit: Hypertension

Me: …So, I sent your refill to the pharmacy and I wrote down the name of your new medication. Any questions?

Patient: Well, uh, yes. One question.

Unspoken comment: Ohhhh, I think I know where there is going.

Patient: Uh, well, what do you know about that thing they show on t.v.? Um, the prostitute…no, uh, prostate thing. You know, the pills to extend your…down below.

Me: You mean the products that claim to lengthen your penis?

Unspoken comment: Sir, are you going to hire a prostitute?

Patient: Well, I was just wondering…does it work?

Me: Honestly, no. It doesn’t work. Don’t waste your money. But on a related note, are you having any difficulties with sexual performance? Is that what you’re worried about?

Patient: Uh, no. I haven’t had sex since my wife died. I was just curious. I won’t buy it.

Unspoken comment: You are going to hire a prostitute, aren’t you?

Me: Well, let us know if you have any concerns about sexual function in the future.

Unspoken comment: Please use a condom!

 

How is it possible? September 14, 2009

Filed under: Uncategorized — lesbonurse @ 10:21 am

How is it possible…

  • That a 100-lb woman drinks five 40-oz bottles of malt liquor a day? (From my co-worker: “wow, you have to be a professional to handle that”)
  • That all of my patients who have blood sugars of 500 feel “fine”?
  • That extra-strength tylenol will totally cure one person’s low back pain, while another person needs a fentanyl patch?
  • That patients think Gatorade is juice?
  • That people who willingly engage in drug abuse, smoke cigarettes and have unprotected sex will refuse a flu shot “because it will make me sick”?
 

Post Labor Day haiku September 9, 2009

Filed under: Uncategorized — lesbonurse @ 1:22 am

A three day weekend

Glorious, but oh so cruel

when it is over.

Want to kill patient:

Missed specialist appointment–

Now have to wait months.

When I recommend

“more exercise,” walking to

the store doesn’t count.

 

Aye aye, matey! September 4, 2009

Filed under: Uncategorized — lesbonurse @ 3:02 am

What’s an illness more associated with pirates than urban dwellers? What illness might you get if you had OCD and your diet for the past 20 years has been limited to only 3 items, none of which are fruits or vegetables? What’s on the far-fetched differential for “mysterious rash”? If you answered SCURVY you are correct! Also, you are smart. Or perhaps extremely knowledgeable about pirates.

Today I saw my first (maybe only?) scurvy patient. The tough stuff–the diagnosis–had already been done several months ago, and today’s visit consisted mostly of me wondering how the hell I was going to make any more progress on the vitamin-C-rich-diet plan when a wicked case of untreated OCD was standing in the way. I didn’t really have any good answers, but I did spend the rest of the day thinking “Heh heh, scurvy!” every few minutes. Which has to count for something, right?