I saw a 92 year old man this morning. He had fallen on a concrete block, hitting his ribs, and landing on his right hand. I sent him for xrays which came back that his hand and one of his ribs are broken. Of course, no orthopedic doctor will see him today, or tomorrow, or any time before next week, so we splinted his right hand and gave him pain meds. I asked him who was going to take care of him at home. He said nobody was, his wife had passed about four years ago, and his kids live in Atlanta. He figures he'll be okay, except he doesn't know how he will cook without the use of his right hand. I suggested he ask his neighbors for help -- this is a small country town after all -- but he is just too ornery and independent to do that. So... well, confidentiality be blowed. One of our assistants goes to the same church as the old man. I asked her to call a few members and get them to check on him over the weekend. Within 10 minutes she had arranged for him to be fed, bathed and tucked in at night. Somehow, I don't think he'll sue me for violating his privacy.
Friday, November 04, 2005
Amazing excuses
Just when you think you've heard it all.....
Drug screened a young woman this morning who is unaccountably losing weight at an alarming pace. Her urine was positive for amphetemines, opiates, and barbiturates. She swore to me that she did not do drugs. Her boyfriend does, though, and when he ejaculates in her, that must be how the drugs got in her system.
Uh huh.
Well, I don't think I'll do the big cancer work-up I was considering.
Drug screened a young woman this morning who is unaccountably losing weight at an alarming pace. Her urine was positive for amphetemines, opiates, and barbiturates. She swore to me that she did not do drugs. Her boyfriend does, though, and when he ejaculates in her, that must be how the drugs got in her system.
Uh huh.
Well, I don't think I'll do the big cancer work-up I was considering.
Thursday, November 03, 2005
Revelation
I had a delightful new patient today. He is an 80 year old man, frail, but completely in possession of all his wits and needing only refills on his regular meds. His wife was with him, and they were just charming. It was noted in his chart that he was allergic to morphine. I asked him what happened when he was given morphine. he and his sweet wife both started laughing. It was clear there was a story there, and because the old gentleman was rather short of breath, his wife shared it with me. It is relevant that this is a white couple, and that the following story contains a word I normally wouldn't consider using.
Mr. White had suffered a heart attack several years earlier. He was admitted to the hospital and placed in ICU, and things were touch and go. He had a great deal of pain, for which they gave him morphine, a normal thing to do for cardiac pain. His wife was at his bedside, and he was pretty much out of it. She sat there worrying that he was going to die.
Suddenly he came wide awake and grabbed her hand. He looked right at her, and seemed to be really with it. He said to her, "Darling, you know, we've been married 45 years, and there is something I never told you. I didn't mean to keep a secret from you, but I've kept this from you all this time, but I have to tell you now."
With understandable fear and trepidation, she asked him, "What is it? What haven't you told me?"
''I'm a nigger," was his response.
He doesn't remember it. He has no idea why he said it. It was really fun to hear them recount the story, and laugh over it. And take pleasure in the many more years they've had together since then.
Mr. White had suffered a heart attack several years earlier. He was admitted to the hospital and placed in ICU, and things were touch and go. He had a great deal of pain, for which they gave him morphine, a normal thing to do for cardiac pain. His wife was at his bedside, and he was pretty much out of it. She sat there worrying that he was going to die.
Suddenly he came wide awake and grabbed her hand. He looked right at her, and seemed to be really with it. He said to her, "Darling, you know, we've been married 45 years, and there is something I never told you. I didn't mean to keep a secret from you, but I've kept this from you all this time, but I have to tell you now."
With understandable fear and trepidation, she asked him, "What is it? What haven't you told me?"
''I'm a nigger," was his response.
He doesn't remember it. He has no idea why he said it. It was really fun to hear them recount the story, and laugh over it. And take pleasure in the many more years they've had together since then.
Wednesday, November 02, 2005
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!
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!
Monday, October 31, 2005
This is so exactly like my younger son. I remember when I first saw the cartoon in the paper, I cut it out and kept it for a long time, then I lost it. I recently found it somewhere along the way in my web travels, and was delighted to have it in my possession again. (and dammit, I had to stop and LOOK UP possession. It just doesn't look right. But it didn't look right when I misspelled it either. phhfft.) 
Are we more than our chemicals?
Drugs scare me. Especially drugs that alter our behavior, feelings, and ways of perceiving the world. And I am not talking about hallucinogens. I am talking about everyday ordinary drugs that your mom might take. That I might take. Uh... that I do take.
I think I have already touched on the fact that without my antidepressant I am irritable, mean, and difficult for even me to be around. I was on hormones for several years after my oophs (as in oophorectomy, or ovariectomy) were removed. Those made a big difference in my behavior too.
And now I am experiencing another mind-altering drug. Prednisone. I have resisted taking it for a long time, but a condition I have called sarcoidosis has flared up to the point it is interfering with my life. I am tired all the time. My spleen hurts. I am short of breath. But being already significantly overweight, I really didn't want to take a drug that would probably make me more so. But my symptoms have just become unbearable, so I called myself in a relatively modest dose of prednisone (10 mg twice a day) and about 7pm tonight, I took my first one.
And at 9pm I suddenly had the urge to clean my bathroom. I couldn't stop there. My floors needed serious vacuuming, so I did it. And the kitchen is always in need of a cleaning, and though my son and his friends had cleaned my kitchen today, I went and finished the job. It is only 10:30 now. When I got home from work, all I wanted to do was fall in bed. Now I feel like sleep is the furthest thing imaginable from my grasp.
I could get addicted to this stuff.
Prednisone. Who'd a thunk it? Anyway, I guess I'll make the most of it while I'm on it. But I do hate being a product of my ingested chemicals rather than my will. I am not the captain of my soul, but only the master of my drugs. So mote it be.
I think I have already touched on the fact that without my antidepressant I am irritable, mean, and difficult for even me to be around. I was on hormones for several years after my oophs (as in oophorectomy, or ovariectomy) were removed. Those made a big difference in my behavior too.
And now I am experiencing another mind-altering drug. Prednisone. I have resisted taking it for a long time, but a condition I have called sarcoidosis has flared up to the point it is interfering with my life. I am tired all the time. My spleen hurts. I am short of breath. But being already significantly overweight, I really didn't want to take a drug that would probably make me more so. But my symptoms have just become unbearable, so I called myself in a relatively modest dose of prednisone (10 mg twice a day) and about 7pm tonight, I took my first one.
And at 9pm I suddenly had the urge to clean my bathroom. I couldn't stop there. My floors needed serious vacuuming, so I did it. And the kitchen is always in need of a cleaning, and though my son and his friends had cleaned my kitchen today, I went and finished the job. It is only 10:30 now. When I got home from work, all I wanted to do was fall in bed. Now I feel like sleep is the furthest thing imaginable from my grasp.
I could get addicted to this stuff.
Prednisone. Who'd a thunk it? Anyway, I guess I'll make the most of it while I'm on it. But I do hate being a product of my ingested chemicals rather than my will. I am not the captain of my soul, but only the master of my drugs. So mote it be.
This is me, supposedly... what kind of faerie are you?
The faerie of water. You have a laid back attitude,
and take life as it comes. People come to you
when they want to hear the truth, even if it
hurts. You will always be there when someone
needs you. People sometimes think you have a
cold heart, that's why sometimes you can also
be known as the Ice Faerie.
What's your inner Faerie?
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