Chief complaints #1 and #2 April 28, 2010

Patient, in exam room with husband.

Me: “What can I do for you today?”

Patient: “I need you to check me for gonorrhea.  Because HE got it.” (shoots evil look at husband)  “Also, my knee hurts.”

Me: “Ok, I can do that.  Did your husband get treated already?”

Patient: “Yes” (another dagger-eyed look at the gonorrhea-ridden husband)

Me: “And did you recently fall or hurt your knee somehow?”

Patient’s husband: “Oh yeah, when she found out about the gonorrhea she jumped on me and started hitting me and I think that’s when she twisted her knee.”

Me: “Oh, ok…”

This is not going to be a pregnancy blog… April 27, 2010

But…I am a pregnant lesbonurse!  It’s exciting news, even if I have been feeling like shit for the past 3 1/2 months.  I’m starting the second trimester, and things seem to be improving (which is good, because I’ve been horribly behind on my work!).  In some ways, my fears about being pregnant at work have not been realized.  I didn’t get terrible smell sensitivities, which I was afraid of since my patients tend towards the heavy cologne-wearing or the unwashed.  I did have constant, sometimes-debilitating nausea, but I never had to throw up in one of the patient bathrooms–or an exam room trash can (which was another fear of mine).  The worst part about the first trimester was the fact that I got really behind on my work–mostly the progress notes–because I had to leave work early every day and spend the rest of the day being lethargic and nauseous on the couch at home.  This actually forced me to tell my bosses that I was pregnant a little earlier than I was planning to, since I started getting emails that read “So, Lesbonurse, our billing department has informed us that you are falling behind on your notes…what’s going on?”  Luckily I work in a baby-positive environment, so the response to my pregnancy was supportive.  Interestingly, though most of my coworkers have offered congratulations, only the other homo in the office actually asked me how my partner and I conceived.  Everyone else has studiously avoided asking any questions about the process.  I thought I would be fielding a lot of “who’s the daddy?” questions, but there have been none.  A few coworkers have asked if my partner is excited, but most people seem content to ignore the queer parenting aspect of my pregnancy.  Oh well, gotta win hearts and minds slowly, right?

So I’m slowly feeling better, and slowly digging myself out of the backlogged work.  I’m hoping to move into the glowing, cute-bellied, visibly preggo nurse practitioner phase.  And I’m sure there will be some pretty fabulously inappropriate patient comments coming up in the next 6 months.

Sex Ed Follow-up April 11, 2010

After my fruitless search for appropriate puberty information (see my last post), I was determined to get something–anything, really–for the clinic.  And I was determined to get some info for my sweet patient, who left with little more than a pep talk about how to talk to her daughter.  Thanks to a friend of mine, I got my hands on a wonderful puberty book, It’s Perfectly Normal.  While I wish I could give a copy of this book away to any patient that wanted it, I settled for copying some of the information and putting the packets into our filing cabinet of patient pamphlets.  Then, in a happy coincidence, my patient with the newly-menstruating daughter came in for an urgent visit.  I came into the room armed with some fresh photocopies about the menstrual cycle and the female reproductive system (all done in cute illustrations, fyi).  I wasn’t sure if my patient would think I was crazy or not as I brandished some papers at her and said, “I was thinking of you and your daughter, so I went out and found this great book…”  It turns out that she was enthusiastic.  She thanked me for the information and left promising to read it with her daughter.   Yes!  Score one for appropriate information!

I do think the book is really great, and I would recommend checking out a copy if you have any contact with children or teens (or adults who need a little basic information about their bodies).

Sex Ed April 2, 2010

My previous post about the patient who didn’t believe she would get pregnant from unprotected sex garnered comments along the lines of “how could she think that?”  It got me thinking about another recent visit.  My patient was a single mother with 2 daughters.  During a routine visit, we were chatting about her kids when she told me that her oldest daughter had gotten her period for the first time.  After a few moments of “Oh my gosh, they grow up so fast” comments, I asked “So, did you talk to her about what this means?”  My patient said “Oh sure, I told her that it means she’s growing up and turning into a woman.”  My next question was “Did you tell her that she can get pregnant now?”  My patient’s answer was, sadly, typical: “Well, I don’t know what to say to her about that.  My mother never talked to me about this stuff.”  Then she asked me what she should say.  I tried to explain the basics of the menstrual cycle and female fertility, in language that she could use with a 12 year-old.  I told her my opinion, which is: knowing that having a period is part of how a woman gets pregnant is really important for adolescent girls.  And knowing that sex is connected to pregnancy is also really important.  After giving the patient my sex ed talk, I ran down the hall to the pediatric clinic to find some pamphlets on puberty or sex.  To my surprise, I found…nothing.  Really, pediatrics?  No information on the menstrual cycle?  No age-appropriate information on sex?  I even asked one of the doctors if they had something hiding in the back of a file cabinet somewhere, but was told that they had no written information on the topic.  Well, I’ll be damned.  No wonder these conversations are hard for parents to have.

Close, but not quite…

• Appointment reason: “Swollen buttocks”  Actual complaint: hemorrhoid.
• Transcribed note, from dictation: “An MRI was done of the parade, and was negative.”  (MRI was done of the brain)
• “My doctor gave me a medication for my nerves.  It was called ‘Filivah'” (Ativan)