More to it than you might think

Being a nurse practitioner is not just about providing health care. Sometimes it is about learning more about people than I ever really wanted to know. I think the following true story illustrates what I mean pretty well. (with a nod to the friend whose conversation got me thinking about this subject -- smooch!)

Naturally, all names and identifying details have been changed in order to comply with HIPPA, not to protect any damn one.

I have a sweet patient I'll call Betty. Betty is about 65 years old, weighs about 280 pounds, has diabetes, arthritis, hypertension and scores of other medical problems. She hadn't had a pap smear in a long time, but I honestly didn't think she was sexually active, and though I should have, I didn't ask. But one day, she told me. (Pap smears aren't terribly important if you aren't sexually active. You don't get exposed to the things that cause cervical cancer if you don't have sex.)

Betty came in very upset one day. She was a bit embarrassed and having trouble getting out what the problem was, so I made myself a bit more comfortable in my chair to give the impression that I was relaxed, listening, and in no hurry. (Hurry someone who's already nervous, and you'll NEVER find out what is going on. Try it.) I said "Betty, it's me. We've known each other for years now. There isn't anything you can't tell me. Just let it out." And I reached over, held her hand, looked kindly (I think -- that's what I intended) into her eyes and I waited.

She hemmed and hawed for a few minutes, looked right and left, and finally looked right at my face and said, "well, when me and my boyfriend were having sex last night, when he pulled his... you know, his..."

"Penis?" I supplied.

Yeah, his penis!"she agreed. "When he pulled it out, well.... It had shit all over it!"

Of course she was horrified.

So I had to ask her if they had been having anal sex. NO! Had there been pain? No. Had she ever noticed stool in her vagina before? No.. and on and on. Finally, there was no help for it, I was going to have to go in. Have a look around. See if anything was wrong. She hadn't had a pap smear in years, so besides having a look-see, I decided to do that too.

The visual inspection revealed a normal anogenital area with lax musculature, maybe a little more lax than usual for a woman her age, but within normal limits. Her anus and vagina were situated in such a way (i.e.: very close together) one could conceivably miss one and hit the other fairly easily. Since there was no fistula or opening communicating between the inner walls of her vagina and rectum, I concluded that her friend must have just missed a few times and moved the substance from one area to the other. No harm, no foul. So far.

A week later the pap smear report comes back. It is great except for a little human papilloma virus -- otherwise known as genital warts. Whoooo. I really am looking forward to telling her this.

I dialed the phone with trepidation. Betty answered. I told her I was calling about her pap smear and she instantly lost her mind. Well, that may be stating it a little strongly. But she started crying and saying, ''Oh my god, something's wrong, I know it, something's wrong!" I tried to calm her, and finally managed to tell her it was an STD. That set her off again. She finally said to me, ''I can't cope with this. Tell my sister Laura. She's right here. Tell her! Explain it to HER!"

Laura is also a patient of mine. She is a couple of years younger than Betty, and suffers fewer health problems... mainly fibromyalgian, hypertension and depression. She is very thin where her sister is very large. The sisters live together. So, I told Laura all about it, about the risk for cancer, about it being an STD, need to notify the partner, and so on. I explained that I would refer Betty to a specialist who could treat her cervix, if needed, to prevent further development of warts or problems. (Understand, these were invisible to the naked eye, only showed up on the microscopic exam they do on the pap smear.) Laura listened, asked some intelligent questions, and that, I thought, was that.

But noooo. This is a twisted tale. Many weeks later, I was asked by a woman I'll call Wilma to write her a letter saying that she was too ill and frail to live alone. (It is widely believed in these parts that a letter from the doctor, or nurse practitioner, as the case may be, will solve any problem.) She IS elderly and prone to falling, and thin and very breakable-looking. I agreed, and asked her what was going on, didn't her son Joe-Bob live with her already?

''Yes,"she said, "But these two huzzies who live in my apartment complex are trying to get him thrown out for lewd and immoral behavior."

"Huzzies? What huzzies? And what is he supposed to have done?" I asked.

''Oh, you know them. Betty and Laura,"she said. "Them gals both had sex with my boy and now they're mad at HIM and claiming he gave them some disease and they are trying to cause trouble! And I need him to be there with me to hep me out aroun' the house. I gotta show that I cain't live alone and I ain't got no other children to take care of me."

Talking later to Betty and Laura on their separate and respective visits, the best I could figure out was that after they got over being mad at each other for having messed around with the other one's boy(!)friend (he is nearly 70 fer cryin'out loud!) they got mad at HIM for giving both of them an STD. And of course, revenge must be had. After all, isn't that what angry women in their 60s do? And they complained to the apartment manager about him.

I don't know the outcome yet. For my friends who really must have closure, I promise an update as soon as I know. This little drama is still unfolding.

And what have I learned from all this? First, never assume ANYTHING. No matter how old and disabled a person might appear to be, they very well may still be having sex. (More than a few people in their 70+ years have laughed at me lately when I have asked about their sex lives. And then told me all about them. )

Secondly, the bonds of sisterhood are stronger by far than any engendered by casual sex.

Lastly, if you are a mom, you may be dealing with the consequences of your offspring's behavior FOREVER!