The magical mystery land of community health

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

Random hilarious bits of documentation February 23, 2011

Filed under: Uncategorized — lesbonurse @ 4:04 am

Read in the charts this week:

  • Hospital admission note: “The patient felt a crushing left-sided chest pain, so he called his friend who had had a MI.  The friend advised him to go to the ER.  The patient stopped to get a cheeseburger and then proceeded to the ER, where he was found to have a ST elevation MI.”
  • Phone message: “Lesbonurse, the patient wants you to call him back to talk about his alcoholism, cirrhosis and to reassure him that he is not going to die within the next 2 months.”
  • Appointment reason: “Multiple Scoliosis”

A Day in the Life of a Community Health NP: New Parent Edition February 8, 2011

Filed under: Uncategorized — lesbonurse @ 2:39 am
7 a.m.: make coffee, eat breakfast and talk to baby while pumping breastmilk (love you, hands-free bustier!).  Send thanks out the the universe for a happy baby who is content to sit in a bouncy seat and chew on her fist while mama frantically tries to get everything done.
7:30 a.m.: Daycare drop-off.  Attempt to look like a caring parent who is not just flinging the baby into the daycare room because she is late to work. Kiss baby.
8 a.m.: First 2 patients are no-shows.  Work on finishing notes from the day before.
8:40-10:40 a.m.: see run-of-the-mill hypertension, sore throat and lab follow up visits
10:45 a.m.: Paranoid schizophrenic, 3 pack a day smoker. Here to follow up on lab results.  Complains of dyspnea on exertion.  No kidding, you smoke 3 packs a day and you find it hard to walk up a flight of stairs?  I’m shocked.  Counsel on smoking cessation.  Secretly think to self that smoking cessation counseling is futile.  Start statin for hyperlipidemia.  Counsel patient about cutting down on fast food intake.  Secretly think to self that lifestyle counseling for cholesterol in this case is futile.  Ask patient to schedule follow up in 4 weeks.  Hope that patient shows up for next appointment.
11:50 a.m.: Finish notes from morning.  Boobs are hurting.  Time to pump!  Feel an almost pathetic amount of anticipation for my date with the breast pump.
12-12:30 p.m.: Pump breastmilk in the “private space” (aka converted utility closet), surrounded by bundles of pamphlets, condoms and insulin syringes.  Eat lunch while pumping.
1 p.m.: Patient thanks me for curing her bronchitis with prednisone and inhalers.  No problem, ma’am!
1:10 p.m.: Patient with what could best be described as a “strange affect” or “Mental illness NOS” tells me that he has been thinking about cutting the skin around his neck and peeling his face up to look at what is underneath.  After ascertaining that this isn’t a real plan and the patient is not a danger to himself, I tell him that it would be pretty difficult to put his skin back on. “No problem,” he says, “I’ll just use superglue.” Um, I don’t think that will work, sir.
1:30 p.m.: See a patient who never takes her meds, have same discussion with her for the 10th time (seriously) about why treating high blood pressure is important.  Threaten to take a picture of myself shaking my finger at her so she can tape it to her wall over her pill bottles.  Patient laughs.  I laugh.  Then I tell her that she’s going to have a stroke.
1:50 p.m.: Observe a physician colleague doing trigger point injections for muscle spasms.  Hope to do trigger point injections on my own someday soon.
2:10 p.m.:Patient with fibromyalgia, requesting med refills
2:30 p.m.: Annual physical exam on a male-to-female transgender patient.  Preparing for the breast exam, she takes off her bra and shows me her “new breasts.”  The new breasts are silicone implant demos with “DO NOT IMPLANT” printed on the backs.  Patient tells me she paid $30 each for them on the street…I wonder which plastic surgeon they were stolen from.
3:20 p.m.: Follow up visit for a male-to-female transgender patient who started on hormones before my maternity leave.  Her labs look great and she says she is feeling “wonderful.”  She looks much happier than when we first met.
3:40 p.m.: Last visit of the day is a narcotic refill for a patient with a mysterious chronic pain that she reports is “extremely severe.”  Narcotics are refilled and patient is referred back to PCP for follow up.
5:00 p.m.: Finish most of my notes, listen to voicemails, do med refill requests, pack up my stuff to go home.  Another day of saving lives!

Return-to-work haiku February 1, 2011

Filed under: Uncategorized — lesbonurse @ 12:59 am

Finish notes at noon,

got a date with the breast pump.

Boobs are exploding!

Two weeks back at work,

No visits for low back pain.

It’s a miracle.

Daycare drop-off is

difficult to manage at