Friday, November 11, 2005
Fantasy
OK, here's my fantasy of the day: In very public circumstances, i.e.: well witnessed by many, Pat Robertson is struck by lightning while an unearthly but clearly female voice, perhaps with a distinct African timbre to it, intones: Mind your own business. And he shouldn't die, he should live through it to try to explain it. I'd just like that.
Tuesday, November 08, 2005
Ever heard of this?
Anybody ever hear of a knee-baby? I just heard that term for the first time today. I'll post later to explain what it is... Unless my faithful readers already know!
Friday, November 04, 2005
Speaking of HIPPA
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.
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?
brought to you by Quizilla
Monday, October 03, 2005
Google ads
Oh well. I am currently cooking some of my favorite addictive substance -- boiled peanuts. I have a huge pot on the stove, filling my whole house with the wondrous aroma of the luscious legumes. That is one of the best things about fall in the south -- freshly harvested peanuts. "Green peanuts" as they are called, though they aren't green at all. I am indulging in a bit of pity for any who have never had the pleasure of this delicacy. (I wonder what kind of ad the mention of boiled peanuts will get me?)
I have been reading a really fun blog recently: celebritysmack.blogspot.com. I first found it when my favorite online magazine - Salon - mentioned something about Jude Law's naked penis having been published all over the internet, and mention was made that surely everyone had seen it by that time. Well, I hadn't, and I hate to be left out, so I went searching for it, and found it in celebritysmack. Plus a ton of other pictures and gossip. Total timewasters, and who cares anyway? But SUCH fun! Check it out... Oh, as for Jude's penis... NBD. Much was made about how small it was, but from my vast experience (as a health care professional!!!!) it is very average. For a white boy. LOL.
It really kills me how much importance is attached to penile size. Even though many women will go to great lengths to increase their breast size, there are some of us who will actually undergo surgery to REDUCE the size of our breasts. I don't think I've ever heard of a man willingly reducing the size of his penis. Cut it off, maybe, but reduce the size? Never! Can you imagine a man saying "gee, I wish I had a nice, compact penis. This dangly thing just gets in my way. And I hate when my SO rolls over on it and squishes it... " No, you aren't ever going to hear that.
Speaking of breasts... There are some really awful ones out there. AwfulPlasticSurgery.com has some great pictures. I do not, and will NEVER, understand the appeal of breasts that look like bolted-on halves of some huge round object. They all look exactly alike. No surprise. I love breasts that are as individual as their owners, with all the various shapes and sizes that human diversity can provide. It is entrancing to watch a bra come off and breasts' true shapes and contours be revealed. I guess I am an old-fashioned lesbian. But I dread the day when everyone looks just alike with chiclet teeth, cheek implants, straight noses, hair extensions, half-globe breasts, lipo-ed bellies and thighs, and butt implants. Goddess preserve us.
I saw a movie yesterday which starred Isabella Rosellini. She is so incredibly beautiful... and then she SMILES -- and oh my god. Those imperfect teeth somehow ENHANCE her beauty. It is amazing. I am so happy she never had them braced or veneered or altered. Her beauty wouldn't be nearly as awe-inspiring without that touch of strangeness to make it uniquely hers.
So maybe the whole world won't go crazy and end up with everyone looking alike. There will always be some beautiful people with sense enough to keep their own beauty instead of trying to be some bland, copy-cat kind of appearance.
And of course, there will always be those of us too poor to indulge in trying to surgically perfect ourselves!
Wednesday, August 31, 2005
4:15 am blues
Wanted to blog a bit, but am awfully tired. Awake because the dog needed to go out. Now she is sleeping blissfully at my side, and I am wide awake. Damn dog. Good thing I love her, else I'd give her to one of those ethnic restaurants reputed to cook those of her kind. .
And now back to seeking sweet, elusive sleep.
And now back to seeking sweet, elusive sleep.
aiiii... I was evil last week. That'll teach me to try to stop my antidepressant medication. I really know better. I have done it before and it never works out for me. So, last week before I resumed my medication, I had this patient who was REALLY pissing me off. I honestly don't often get pissed off by patients. I don't. I love my patients, and I try to do my best by them. But this guy... well, first of all, I could smell him from the other end of the building. He likes cheap, loud cologne. I hate it passionately. So I was pissed immediately, just from his swirling miasma. I have even told him how offensive I find his cologne. It makes me sneeze, makes my eyes water and generally makes me unhappy. So the mere fact that he wore it when he had an appointment with me was clearly an affront.
I enter the room and Bubba, as we'll call him here, was in a rare good humor. He has reasons not to be. He has insulin dependent diabetes with all the nasty things that go along with it - poor vision, nerve damage that causes pain in his feet and legs, heart damage, early kidney failure.... the list goes on, but you get the idea. He comes here for pain management mostly. And he does have pain, no doubt about it. But geez.... he has gradually worked Doc until he is on oxycontin 80 mg twice a day along with which he gets 180 hydrocodone tablets (eg, vicodin, lorcet) a month for his breakthrough pain. Eighty milligrams of oxycontin is equivalent to 8 of the highest strength percodans, and he takes two of them a day -- which is like taking SIXTEEN percodan a DAY. Plus 6 lorcet a day in case the oxycontin doesn't do it. Well, he's a big man, and he and Doc settled on his pain medicine regimen. None of my business.
Except Doc wasn't there that day, and I had to see Bubba. Bubba had last gotten his medicines 19 days prior to this particular day. He was there to see me for two reasons. He was out of his lorcet already (ONE HUNDRED AND EIGHTY of them!!) not to mention that he had on one of his brother's fentanyl patches, and he liked it and wanted some of them too! (Fentanyl is a high-power synthetic narcotic delivered through the skin.... or IV in the operating room. It is easily as strong as the oxycontin, if not stronger.) He wanted more lorcet, since he was out.
Hence the good mood, I suppose. I mean, I don't know how he walked. Or stood, or even spoke. If he indeed took all his prescribed meds, (and lord knows, he may have been selling most of them and still had enough left to be high as a kite all the time), it is a wonder the added fentanyl that he decided on his own to use didn't kill him.
I chastised him for doing that. I told him it was against the law, and indeed was a felony, both for him to take it and for his brother to have given it to him. Not to mention it could have killed him, considering all the other narcotics he was taking. He became surly. He let a tear drip down his cheek. He started whining (oh gawd how I hate whining, especially from grown men!) about how severe his pain was, how I didn't understand how often he lay awake at night crying, and about how much he wanted to be dead. Yes, he emphasized to me, he just really wanted to be dead more than anything.
Oh dear. He shouldn't have said that. It was so calculated to make me just go all soft and buttery and sympathetic. I gave him the cold fish-eye and said, Bubba, you are a grown man. If you really wanted to be dead you COULD be. I went from there into a rant: You sure have plenty of drugs to do it with! And I bet you have at least 16 guns in your house! (here he interjected sadly that someone had stolen all but 3 of his guns -- which I ignored and continued) You are willing to risk not only your life and health taking all these drugs, but you are risking MY license! How dare you? I wouldn't risk my license for someone I liked, I SURE wouldn't risk it for YOU! I ranted on in that vein for probably ten minutes.
When I stopped to take a breath, he asked me, Does that mean you aren't going to give me any more lorcet today?
I was spent. I shook my head and left the room. I could still hear him complaining that he was out of lorcet and really needed more.
I am better this week. I haven't ranted at a single patient.
And finally, a warm and personal HI! to a special girl out there. :)
I enter the room and Bubba, as we'll call him here, was in a rare good humor. He has reasons not to be. He has insulin dependent diabetes with all the nasty things that go along with it - poor vision, nerve damage that causes pain in his feet and legs, heart damage, early kidney failure.... the list goes on, but you get the idea. He comes here for pain management mostly. And he does have pain, no doubt about it. But geez.... he has gradually worked Doc until he is on oxycontin 80 mg twice a day along with which he gets 180 hydrocodone tablets (eg, vicodin, lorcet) a month for his breakthrough pain. Eighty milligrams of oxycontin is equivalent to 8 of the highest strength percodans, and he takes two of them a day -- which is like taking SIXTEEN percodan a DAY. Plus 6 lorcet a day in case the oxycontin doesn't do it. Well, he's a big man, and he and Doc settled on his pain medicine regimen. None of my business.
Except Doc wasn't there that day, and I had to see Bubba. Bubba had last gotten his medicines 19 days prior to this particular day. He was there to see me for two reasons. He was out of his lorcet already (ONE HUNDRED AND EIGHTY of them!!) not to mention that he had on one of his brother's fentanyl patches, and he liked it and wanted some of them too! (Fentanyl is a high-power synthetic narcotic delivered through the skin.... or IV in the operating room. It is easily as strong as the oxycontin, if not stronger.) He wanted more lorcet, since he was out.
Hence the good mood, I suppose. I mean, I don't know how he walked. Or stood, or even spoke. If he indeed took all his prescribed meds, (and lord knows, he may have been selling most of them and still had enough left to be high as a kite all the time), it is a wonder the added fentanyl that he decided on his own to use didn't kill him.
I chastised him for doing that. I told him it was against the law, and indeed was a felony, both for him to take it and for his brother to have given it to him. Not to mention it could have killed him, considering all the other narcotics he was taking. He became surly. He let a tear drip down his cheek. He started whining (oh gawd how I hate whining, especially from grown men!) about how severe his pain was, how I didn't understand how often he lay awake at night crying, and about how much he wanted to be dead. Yes, he emphasized to me, he just really wanted to be dead more than anything.
Oh dear. He shouldn't have said that. It was so calculated to make me just go all soft and buttery and sympathetic. I gave him the cold fish-eye and said, Bubba, you are a grown man. If you really wanted to be dead you COULD be. I went from there into a rant: You sure have plenty of drugs to do it with! And I bet you have at least 16 guns in your house! (here he interjected sadly that someone had stolen all but 3 of his guns -- which I ignored and continued) You are willing to risk not only your life and health taking all these drugs, but you are risking MY license! How dare you? I wouldn't risk my license for someone I liked, I SURE wouldn't risk it for YOU! I ranted on in that vein for probably ten minutes.
When I stopped to take a breath, he asked me, Does that mean you aren't going to give me any more lorcet today?
I was spent. I shook my head and left the room. I could still hear him complaining that he was out of lorcet and really needed more.
I am better this week. I haven't ranted at a single patient.
And finally, a warm and personal HI! to a special girl out there. :)
Sunday, June 12, 2005
Health Care for All
I have come to the conclusion that if you need health care and can't get it any other way, (i.e., you have no insurance, you have no money, you have no credit cards....) you go to a small town or country doctor. Many people have caught on to this. I don't know quite how... maybe it is word of mouth from their country cousins. All I know is that the small rural practice where I work has recently been flooded with new patients -- from the nearby big city.
It struck me as odd from the beginning. The nearby big city is full of health care providers of every ilk and specialty. They have several large hospitals to which they may refer extremely ill patients. They have excellent reputations (well, some of them, anyway.) It blew my mind to see a patient with several serious, non-routine diagnoses in my office recently. I am not even a doctor, I am a nurse practitioner. Not to belittle my expertise in any way, but hey, I know my limits! The woman listed the names of her specialists for her various conditions. I sat there bemused, and finally asked her, "Why did you come here? You were getting the best of care." Her answer? Money, of course. She had lost her insurance when she was laid off from her job. She couldn't afford the specialists' fees. She couldn't afford her medications. She had heard that we would see patients on a sliding fee basis, and that we would help them get free medicine.
So I got out my books, and with her knowledge of her own condition, what I was able to look up, and her list of her current meds, we were able to map out a care plan for her. She was stable on her meds. I had forms from the companies that made them so that we could apply for free or reduced cost medicines. I did a physical exam and documented her current condition so we could be alert for changes. I looked up what labs to order and ordered them.
She fully understands that I have no expertise in her conditions. I fully understand that she is stuck with me because her financial situation won't pay for the specialists she needs. Perhaps I should refuse to take on the care of a patient so complex, but surely I am better than nothing.
But I deeply resent out current system in which patients must utilize care that is less than optimal. Yes, I'll do my best for her. But she deserves better.
It struck me as odd from the beginning. The nearby big city is full of health care providers of every ilk and specialty. They have several large hospitals to which they may refer extremely ill patients. They have excellent reputations (well, some of them, anyway.) It blew my mind to see a patient with several serious, non-routine diagnoses in my office recently. I am not even a doctor, I am a nurse practitioner. Not to belittle my expertise in any way, but hey, I know my limits! The woman listed the names of her specialists for her various conditions. I sat there bemused, and finally asked her, "Why did you come here? You were getting the best of care." Her answer? Money, of course. She had lost her insurance when she was laid off from her job. She couldn't afford the specialists' fees. She couldn't afford her medications. She had heard that we would see patients on a sliding fee basis, and that we would help them get free medicine.
So I got out my books, and with her knowledge of her own condition, what I was able to look up, and her list of her current meds, we were able to map out a care plan for her. She was stable on her meds. I had forms from the companies that made them so that we could apply for free or reduced cost medicines. I did a physical exam and documented her current condition so we could be alert for changes. I looked up what labs to order and ordered them.
She fully understands that I have no expertise in her conditions. I fully understand that she is stuck with me because her financial situation won't pay for the specialists she needs. Perhaps I should refuse to take on the care of a patient so complex, but surely I am better than nothing.
But I deeply resent out current system in which patients must utilize care that is less than optimal. Yes, I'll do my best for her. But she deserves better.
Sunday, June 05, 2005
Saturday, June 04, 2005
The Angry Greek Man
'Twas a long time ago; so long I am not sure my memory is fully accurate, but let me try to get the story right...
I was desperately in love. I was lonely, bereft, recently abandoned by my ex-husband, and coming to the realization that I was a lesbian. I had had a crush on a woman; a writer with whom I had been acquainted for quite some time. She had moved to Greece and married a Greek man, but I knew she was a lesbian. I didn't know really why she married. It didn't matter though. She seemed a safe distance away, so I professed my crush to her and waited to see what would happen.
What happened first was a wonderful and passionate correspondence between the two of us. Her letters were clever, witty, biting, sarcastic, funny and tender. I suppose mine were doltish by comparison. She was a most talented writer.
Before long it was time for the holidays. She was coming home from Greece with her husband to spend the holidays with her family. And to see ME! I was beside myself. I hardly even acknowledged to myself that she had a husband. I was going to see her. I might touch her. I would smell her hair.
At the time, I lived far in the country down almost three miles of dirt road. I lived in a large house with my two very young sons. I did have a helper -- an old black man named Talmadge. Talmadge looked after us well. I think he felt sorry for me -- a divorced woman alone in the world with no man to look after her. Talmadge spoke in a deep 'Geechee accent which was difficult even for me, a hardcore southerner, to understand. Besides caring for me and my boys, he figures in this story a little later, so I figure I might as well introduce him now.
The holiday came, and so did my wonderful beloved and her immaterial husband. I had worked hard getting my house cleaned and welcoming. I cooked all day. I sent my boys off with their father. I selected wine. I still smoked then, and I smoked a lot that day. They arrived at last. She was beautiful. We talked of many things, but the only one I remember was his hideous foot fungus, the sight of which I was treated to because I am a nurse, and that's what happens when you are a nurse. It grew late. I begged them to stay the night. Somehow, she ended up in my bed, while the egregious Greek man was left on the couch downstairs.
I remember she and I giggled and talked and cuddled nearly all night long. We smoked, though the cigarettes seemed not to agree with her. We finally slept.
When it was morning at last, we sat in bed looking at one another wondering what on earth we had done. The house felt empty except for ourselves -- a fact we discussed in whispers. Finally we gained enough courage to go downstairs to look. Of course he was gone.
We walked outside and could see the distinctive footprints left by the Greek man's shoes in the driveway. They went to the road and took a left turn -- toward Talmadge's house. We laughed nervously at the idea of the Greek with his thick Greek accent meeting up with Tal and his thicker 'Geechee one. My nameless (here anyway) love called her parents' home to see if he was there. He wasn't. So I called Talmadge to see if indeed he had encountered His Greekness. He had.
Talmadge told me how he had just left his home very early in the morning and encountered a lone "white man" walking on the dirt road near his house. Tal picked him up because the man was well-dressed and looked utterly lost and out of place. Apparently it took a while for them to understand one another, but Tal finally understood that the man wanted to go to the bus station. (His wife and I had a guilty giggle over this-- sometime in the previous evening we had laughed over the fact that one thing all small towns seem to have in common is a bus station.) Tal delivered the Greek to the local one, and that was the last anyone ever heard of him.
My beloved had wildly mixed emotions over that, but not I. I was thrilled. She was mine alone now. The way was clear. I wasn't burdened (as she was) by the guilt of having treated him rather horribly. But of course, neither of us knew at that point that she was
pregnant.
I was desperately in love. I was lonely, bereft, recently abandoned by my ex-husband, and coming to the realization that I was a lesbian. I had had a crush on a woman; a writer with whom I had been acquainted for quite some time. She had moved to Greece and married a Greek man, but I knew she was a lesbian. I didn't know really why she married. It didn't matter though. She seemed a safe distance away, so I professed my crush to her and waited to see what would happen.
What happened first was a wonderful and passionate correspondence between the two of us. Her letters were clever, witty, biting, sarcastic, funny and tender. I suppose mine were doltish by comparison. She was a most talented writer.
Before long it was time for the holidays. She was coming home from Greece with her husband to spend the holidays with her family. And to see ME! I was beside myself. I hardly even acknowledged to myself that she had a husband. I was going to see her. I might touch her. I would smell her hair.
At the time, I lived far in the country down almost three miles of dirt road. I lived in a large house with my two very young sons. I did have a helper -- an old black man named Talmadge. Talmadge looked after us well. I think he felt sorry for me -- a divorced woman alone in the world with no man to look after her. Talmadge spoke in a deep 'Geechee accent which was difficult even for me, a hardcore southerner, to understand. Besides caring for me and my boys, he figures in this story a little later, so I figure I might as well introduce him now.
The holiday came, and so did my wonderful beloved and her immaterial husband. I had worked hard getting my house cleaned and welcoming. I cooked all day. I sent my boys off with their father. I selected wine. I still smoked then, and I smoked a lot that day. They arrived at last. She was beautiful. We talked of many things, but the only one I remember was his hideous foot fungus, the sight of which I was treated to because I am a nurse, and that's what happens when you are a nurse. It grew late. I begged them to stay the night. Somehow, she ended up in my bed, while the egregious Greek man was left on the couch downstairs.
I remember she and I giggled and talked and cuddled nearly all night long. We smoked, though the cigarettes seemed not to agree with her. We finally slept.
When it was morning at last, we sat in bed looking at one another wondering what on earth we had done. The house felt empty except for ourselves -- a fact we discussed in whispers. Finally we gained enough courage to go downstairs to look. Of course he was gone.
We walked outside and could see the distinctive footprints left by the Greek man's shoes in the driveway. They went to the road and took a left turn -- toward Talmadge's house. We laughed nervously at the idea of the Greek with his thick Greek accent meeting up with Tal and his thicker 'Geechee one. My nameless (here anyway) love called her parents' home to see if he was there. He wasn't. So I called Talmadge to see if indeed he had encountered His Greekness. He had.
Talmadge told me how he had just left his home very early in the morning and encountered a lone "white man" walking on the dirt road near his house. Tal picked him up because the man was well-dressed and looked utterly lost and out of place. Apparently it took a while for them to understand one another, but Tal finally understood that the man wanted to go to the bus station. (His wife and I had a guilty giggle over this-- sometime in the previous evening we had laughed over the fact that one thing all small towns seem to have in common is a bus station.) Tal delivered the Greek to the local one, and that was the last anyone ever heard of him.
My beloved had wildly mixed emotions over that, but not I. I was thrilled. She was mine alone now. The way was clear. I wasn't burdened (as she was) by the guilt of having treated him rather horribly. But of course, neither of us knew at that point that she was
pregnant.
Friday, June 03, 2005
I have to comment on the woman whose dog's feet smelled like fritos. They did indeed. I had NEVER before noticed the aroma of dog feet, but her noticing that interesting aspect of her dog's composition has had me sniffing dog feet ever since. And you know what? They ALL have frito-feet. I just hope this isn't because they tend to step in their urine.
Animals are odd creatures. I have found out other fascinating things about animals along the way. For example, if you wrap an ace bandage around a cat's belly, it can't walk. It will stumble and fall. I have tried this on many cats. The bandage doesn't have to be wrapped tightly. No cats were injured in any way during these experiments. I swear. I love animals! But it is a weird truth that they cannot walk with any stability with a bandage around their bellies. I do need to do further research though, and find out if this is true of anything wrapped around their middles, or only elastic things.
I have also learned a strange and interesting thing about parrot behavior. My parrot likes to nip fingers, but he won't do it as long as I stare into his eyes aggressively. But if I am doing that, he will duck his head under my hand where he can't see my eyes, and nip my fingers from BELOW my hand. Damn bird. But this is a very limited experiment. I have only used it on one bird. I'll let you know when I have collected more data.
I don't know what it is about animals that appeals to me so much. Clearly, I spend too much time with mine. I often think how much simpler (and less smelly) my life would be with no pets. But somehow, I have managed to always have at least one in my life, and usually far more than one. Even if I do nothing to actively acquire animals, they just show up. Right now the count is pretty moderate: one dog, four cats, one bird, and a couple dozen fish. Not bad really, until I want to go on vacation. It is almost as hard to get someone to keep your animals as it is to get someone to keep your kids...
oh -- to the woman with the frito-footed dog -- give me a call sometime. It might be interesting to catch up a bit. :)
Animals are odd creatures. I have found out other fascinating things about animals along the way. For example, if you wrap an ace bandage around a cat's belly, it can't walk. It will stumble and fall. I have tried this on many cats. The bandage doesn't have to be wrapped tightly. No cats were injured in any way during these experiments. I swear. I love animals! But it is a weird truth that they cannot walk with any stability with a bandage around their bellies. I do need to do further research though, and find out if this is true of anything wrapped around their middles, or only elastic things.
I have also learned a strange and interesting thing about parrot behavior. My parrot likes to nip fingers, but he won't do it as long as I stare into his eyes aggressively. But if I am doing that, he will duck his head under my hand where he can't see my eyes, and nip my fingers from BELOW my hand. Damn bird. But this is a very limited experiment. I have only used it on one bird. I'll let you know when I have collected more data.
I don't know what it is about animals that appeals to me so much. Clearly, I spend too much time with mine. I often think how much simpler (and less smelly) my life would be with no pets. But somehow, I have managed to always have at least one in my life, and usually far more than one. Even if I do nothing to actively acquire animals, they just show up. Right now the count is pretty moderate: one dog, four cats, one bird, and a couple dozen fish. Not bad really, until I want to go on vacation. It is almost as hard to get someone to keep your animals as it is to get someone to keep your kids...
oh -- to the woman with the frito-footed dog -- give me a call sometime. It might be interesting to catch up a bit. :)
Tuesday, March 01, 2005
The nun's belly was so smooth and utterly unmarred. No scars, no bruises, nothing but a modest expanse of alabaster skin. I put my hands on her belly, gently at first, lightly scanning the lovely skin to get a sense of it before probing more deeply. I started over on the left side, the unaffected side. I pushed in with my fingertips, causing a slight wince. Releasing the pressure caused more than a wince. I asked her where it hurt and she indicated her right side. I moved my hands to the painful side. Before I even applied pressure, I could feel warmth and fullness. It wasn't apparent to my eyes, but my hands could tell something was wrong. I pushed in very gently, causing pain. When I released my pressure this time, the nun blanched and gasped. I told her what I thought -- that her appendix was infected. She refuted me -- it couldn't be -- she had Ash Wednesday services the next day, and she was flying to Seattle the following Monday. She simply was too busy to be sick.
But she looked sick. This lovely nun normally had a sparkly, shiny aura. She always smiled. She smiled this day too, but it wasn't a glowing smile. She was grey.
I agreed not to send her immediately to the hospital. She agreed to let me draw blood and arrange a CT of her abdomen for the next morning. (This was late in the day. I could get the CT early the next morning, prior to her Ash Wednesday services.) I was worried. I made her promise to go right to the ER should her pain worsen, or her fever go up. She agreed.
The next morning we got a fax from the imaging department. The nun had appendicitis. The hard thing was finding her. I called her home, the church, her emergency number. All I got was recordings. I left messages, but was not happy about it. I was considering calling the police to go find her, but first asked my doctor what he would do.
One of his talents is knowing everyone. He knew who the nun's best friend was. He called her and told her what was going on. The friend knew where she was. Within 15 minutes she had called me back and we made arrangements for her to go right to the hospital.
Her appendix was removed in short order, and she was home in time to make her flight to Seattle.
And I will never forget her lovely smooth belly. It was the prettiest belly I have ever seen. I think I am in love.
But she looked sick. This lovely nun normally had a sparkly, shiny aura. She always smiled. She smiled this day too, but it wasn't a glowing smile. She was grey.
I agreed not to send her immediately to the hospital. She agreed to let me draw blood and arrange a CT of her abdomen for the next morning. (This was late in the day. I could get the CT early the next morning, prior to her Ash Wednesday services.) I was worried. I made her promise to go right to the ER should her pain worsen, or her fever go up. She agreed.
The next morning we got a fax from the imaging department. The nun had appendicitis. The hard thing was finding her. I called her home, the church, her emergency number. All I got was recordings. I left messages, but was not happy about it. I was considering calling the police to go find her, but first asked my doctor what he would do.
One of his talents is knowing everyone. He knew who the nun's best friend was. He called her and told her what was going on. The friend knew where she was. Within 15 minutes she had called me back and we made arrangements for her to go right to the hospital.
Her appendix was removed in short order, and she was home in time to make her flight to Seattle.
And I will never forget her lovely smooth belly. It was the prettiest belly I have ever seen. I think I am in love.
Saturday, January 08, 2005
I woke up with an Amazon in my bed this morning. A parrot. My son's. Actually, I think the parrot is mine now. The son is planning to move away soon, and he asked if he could leave Veda with me. I am happy to keep the bird -- Veda and I have bonded. It took a long time, but it happened. Veda is so beautiful, and he talks too. He screams my younger son's name frequently, or sits and mutters all kinds of things, or puts together words to form new meanings. I think he is intelligent. He likes to kiss me. Birds kiss by nibbling at or touching their tongues to your lips. After a recent session of bird-kissing, I found my lips to be burning fiercely. I nearly freaked out, wondering what kind of bird-enzyme I'd been poisoned with. Then it came to me -- parrot food has dried hot peppers in it. Parrots love hot peppers. Apparently, Veda had been nibbling one before nibbling at my lips... and the burning faded away after a short time...
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