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Archive for the ‘Humor’ Category


A few days ago a patient came in upset about her arm after being in the hospital for a couple of days. She is a lovely older woman I had seen a couple of times before, so when the nurse told me the patient’s arm was swollen, and “fibers” were coming out of the area that the IV had been, I was worried. I tapped on the door and went into the exam room. She was sitting in the chair with an anxious look on her face, holding her left arm out stiffly.

When I looked at the arm, I didn’t see any swelling or bruising, no redness, nothing. She pointed to her forearm and said “Look, see this dark area, there are fibers coming out of it! What is wrong, what could do that?” She was visibly upset. I looked where she was pointing and saw the distinctive square outline of tape marked in leftover adhesive. Little bits of thread and lint were stuck on it. ….Oh.

I explained to her what she was seeing. “Do you mean that all that is, is DIRT? I am so embarrassed, my husband will laugh at me!” After cleaning off the adhesive with an alcohol prep pad, I suggested that she could tell her husband she had a bad case of adhesodermatitis, but we were able to treat it successfully. She liked that and left with a smile.

So, the first two parts of the project are done: the matrix and the evaluative summary (review of literature). The entire floor of my study room and all available horizontal surfaces are covered in articles and studies duly printed on my printer after a “literature search” on all of those lovely databases. Most were rejected, 20 remained and were loaded into the matrix. Did any of you see that movie? I felt like one of those people in the little pods by the time I was done. My entire world had shrunk to the size of my laptop screen, the actual reality world disappeared. My husband forgot what I looked like and my dogs gave up on presenting enticing toys for me to play with.

The end result of all that study? I found out that the available research about diabetic foot ulcers and preventive education basically sucks. I barely managed to get enough info to do the project. Hope I still get a decent grade.

Actually,  I lied about the dogs not giving me toys. One of them thought I might be tempted with a mouse. Here I am, in crisp white lab-coat, ready to go out the door to clinical and…..

Yikes! But he was sooooo proud of himself!

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Well, my last term starts Monday. I just got back from a week of vacation in upstate South Carolina, again. We do love it there. I managed to wash and dry my cell phone (we thought the dryer was clumping kind of loud) and so no-one could call me. That actually was kind of nice. We took walks in the woods with the dogs, explored the area and discovered some new things. Generally relaxed and lollygagged (also gained a few pounds, oops). I took several school books with good intentions of doing some reading. Yea, right.

Now, I am home again, faced with the pile of books I meant to do some reading and studying in and the new term looms. I was good today, read a few chapters in my orthopedic book. Orthopedics is one of my weaker areas and I need to bone up a bit. It seems strange that there is only one more term, 15 more weeks. I am so not ready to go out there and BE a nurse practitioner. Emotionally scary, that. I suppose that is how all new grads feel when they go out there, so I will try not to perseverate about it.

My big concern this time is the SCHOLARLY PROJECT…..the dreaded thesis of yore. A classmate who is a term ahead of me stated she almost threw up when she read the syllabus and expectations of the scholarly project. Okay, I suppose that is good to know ahead of time. She did say to really work your ass off the first week to fill in the “matrix” and the rest would flow.  Now if I could just think of a good subject, which is a little hard to do if you don’t know the expectations. I have fiddled with the ideas of diabetic foot care, the shingles vaccine, medication compliance issues and fall prevention in the elderly. 

Last term I was still excited about getting the books and prepping my work space. This term is different, motivation seems to lower. The difference must be pretty much sheer exhaustion, mental and physical, and also the realization that, once this is done, I need to go out there and apply for jobs. Yuk, I hate applying for jobs. In the past, every time I thought I was getting a good one and the people seemed nice and all that, the job turned into a disease. The employer owned you for a salary, and always took advantage. I am too damn old for those games now. I hope that I can find a nice quiet little corner to do my thing, working with nice people who appreciate me. Is that too much to ask? Hopefully not. I work hard, I am honest, I care about how and what I do. Sending up prayers, God, that the right place will come up for me. Heaven knows I have worked hard enough to get to where I am educationally.

So, here we are, sitting at the desk. It is dusty, there are coffee rings on the surface. The books are stacked a little haphazardly. The pencils are not sharp. Piles of old clinical log sheets and papers take up half the space. The laptop is new, the old one fell off the sofa and died a spectacular death. I never saw such weird patterns on the display before…at least that was after I took my final. Do I feel like making it all pretty and tidy? Not this time. The piles of papers will have to go on the floor to make room for the new ones. I will push enough stuff aside to make space for the new stuff, and I will continue to plug away at all of this, including the “matrix”, until is done. 15 more weeks…

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One thing I have learned is that the presenting complaint is never what you think it is.

Foot pain: An elderly lady came in complaining of foot pain. She had told the nurse it was bothering her a lot and wanted to know what to do about it. On examination there appreared to be a crusty area between the last two toes of one of her feet. She points out “It was pretty swollen up for a while”. I try to gently clean away some of the crusty stuff and just see a little bit of a macerated area. I questioned her if she had a podiatrist as she was diabetic and she said she did.

 “He operated on that toe a while back, and the nurse came and dressed it and they took out the stitches last week”. Okay……..Well, I advised her if it was still sore she should check with the podiatrist. She agreed that was a good idea, she denied any other issues when I asked if there was anything else she wanted to talk about.

I left to give my report to my preceptor, the good doctor….he agreed the patient should return to the podiatrist to have it checked.

We go back in the room. “So,” he says, ” I hear you are having some trouble with your foot, but that you are going to get the podiatrist who operated on it to check it out.”

“That’s right”, she says, “But that’s not why I came in today, I wanted to talk about my cough.”

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I have now spent four days clinical time at the health department. I like my new preceptor, she is patient and receptive to questions. I tend to ask a lot of questions…

I have seen a lot of patients and am finding that they seem to belong to three groups in general.

1. Those who have no insurance or are on Medicaid, and find that the health department primary care clinic is a reasonable option for basic health care needs. The amount billed is based on financial need on a scale ranging from full pay to free care. It is a pleasure to help them meet their health care needs, I know what it is like not to have insurance, so I can relate. These people are happy to get the care and tend to follow the treatment plan set up for them.

2. The walking train wrecks. These are people who wait until the latest possible moment to seek health care for a problem they have, or they wait until they have several problems, and try to pile them all into one visit. For example it might go something like this: I have had a runny nose and cough for three weeks and now it hurts to breathe, and I have this really big pimple on my butt that just keeps getting bigger, and I ran out of blood pressure medications 2 weeks ago and my back hurts really bad.

3. The yes, buts. These are people who come in very regularly claiming to feel lousy (and they most probably do feel lousy) and want you to fix them up, or maybe really not. This is what I mean…

Okay Mrs. Smith, I see you are here for your diabetes and blood pressure check. Did you bring your sugar readings log?

“I would’ve, but I forgot. They have been much better, in the low 100’s.

Mrs. Smith, that can’t be quite right, your A1c reading is 11.3  which is higher than last time. This reading indicates that your average blood sugar is in the high 200’s, not the 100’s.

Yes, but that was because of the holidays, it really has been lower most of the time.

I really need you to bring in your log next time, okay. Have you been following your diet?

Yes, but it is too hard to follow and I really like to eat, so I don’t always.

Are you walking 30 minutes at least three or four times a week? Remember how important it is to exercise?

Yes, but  a lot of days I forget, or it is too hot out.

You know it is very important to take your blood pressure medication every day as prescribed, are you taking your meds? Your blood pressure is quite high today.

Yes, but I don’t like the water pill. It makes me go to the bathroom too much, and I didn’t get my refills yet, so I ran out yesterday. Do you have any free samples? I just forget to take them sometimes.

Did you get the medication box we discussed that you can fill each week so you can remember to take your meds?

Yes, but I forget to fill it up. Oh, and my feet are swelling up really bad, can you do something about that? I am feeling so tired lately, and I gained 6 pounds last week. Is there a pill I can take to lose weight?

 

I swear, some people just like to complain, and if I hear “yes, but”  one more time, I may scream. Well, maybe not, but I’ll roll my eyes when they aren’t looking.


 

 

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Actual studies that money was wasted on:

  • Gaining weight increases risk of heart disease: I thought we knew that already?
  • Heavy drinking is linked to impulsive behavior in teen boys: Do ya think? How about the girls?
  • Sex and alcohol drinking more common in kids who dislike school: No, really?
  • Smokers with breast cancer have a higher risk of death: duh.
  • Study finds heart health benefits of taking chocolate in women over 70: Okay, but what about women under 70?
  • Study links excessive texting (over 120 per day) with sex, drugs and alcohol in high school students: I have a couple of issues with this. I would consider 10 or 20 texts a day as excessive, and if you are sending over 120 a day, when do you have time for sex, drugs and alcohol, not to mention school? Does this mean if you take away their cell phones, they will stay away from the sex, drugs and alcohol?
  • Children of deployed parents have more stress and behavior problems: this is sad, and obvious. I would have preferred this money to be spent in ways to support these families.
  • Sugary drinks may increase risk for diabetes and metabolic syndrome: I think this has been common knowledge for quite a while, no?
  • Brain tumor risk reduced in those who drink at least 3 ounces of tea or coffee a day: Cool, with the gallons I drink everyday, I guess I won’t get brain cancer, 🙂
  • Dog fleas jump higher than cat fleas: now, there is a truly useful bit of info…
  • Teens who engage in oral sex are at higher risk for intercourse: they had to do research to discover this?
  • Teenagers who play video games spend less time on homework: any mom or dad could have told you that for free.
  • Spraying quinine almost continuously on chickens reduces feather pecking: the importance of this research is staggering

Okay, I am going to go now and have some brain tumor prevention fluid.

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I know the title is not exactly an original, but darned if it isn’t true. As my readers know, most of my previous experience has been with older folks, and hospice patients. Now, as part of getting my Family Nurse Practitioner certification, I am in the pediatric rotation.

Of course, it had to be the first rotation. Downright scary. But after 12 weeks with the little munchkins, and it doesn’t seem quite so scary. Lots of sore throats, ear aches and rashes, with a dash of constipation, picky eating and temper tantrums thrown in for variety. I can handle that.

The best part was, you never knew what would come out of their mouths at any given moment. One little tot loudly announced to everyone in the waiting room, hallway and exam areas: “My mom is having another baby!” Mom rolls her eyes and sighs, secret’s out.

Another little gal pointed at my Mr Long Ears and said “I am going to have a stepostope for Christmas.” I asked her if she was going to be a nurse or doctor, “No, I am going to be race car driver.”

I entered an exam room for a school physical on a six year old boy. He was perched, fully clothed on the exam table, a serious frown on his little face. “I will NOT take off my clothes.” Mom and I came up with the idea that I would take the cooperative sister across the hall for her physical, and Mom would try to pry the clothes off the recalcitrant one. When I returned, he was crouched in a little ball with shreds of paper gown fluttering all around him.

He glared at me and said solemnly “I am a MAN, and no-one is going to see me naked!” After a little persuausion, he finally allowed the exam, but when I felt for his femoral pulses (in his groin) he yelled “THAT is what I was talking about!” I could hear some snickering coming from Mom, but she was able to keep from bursting out.

One boy’s name was William, I asked him what he liked to be called, William or Bill or what. He said “My name is Bill, but Dad calls me pain in the ass.

Oh, I gotta go, I just saw a bald eagle swoop down in our lake, I think he caught a fish, so cool!

He did!

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One of the first things a new clinical rotation does to you is create a sense of anxiety. It seems like you don’t know anything (this is only me, after all, what do I know?). Reading stuff in a text book is WAY diferent than confronting a patient face-to-face. Each knock at the exam room door before you enter has a particular uncertainty to it. What will you see on the other side? Will the parents be nice, or look at you with that look that says “Not only are you not a doctor, but a student nurse practitioner”? Will the problem be obvious, or will it be one of those times where the diagnosis could be one of a dozen options, for example: rash or a fever? Can I maintain the professional persona, or will I melt into a blithering idiot?

I have to do what I told my LPN students when I first took them into a clinical: “You have done all of this in lab, just go in there and pretend you have done it a million times already, just act professional and you will feel professional.” Ha!, Those words are haunting me now!

A few weeks ago (my excuse for this story is that it happened early in the clinical rotation, I never panic now…….really, never) I got a patient with a presenting complaint of high fever for several days, recorded around 103+ by Mom.  I knocked on the exam room door with my stethoscope draped around my neck and Miss Brightlight clutched in my hand, and entered. The mom was sitting in the chair with her three-year-old across her lap. He looked very pale, his eyes were closed, and there was no reaction to me entering the room and introducing myself. Mom and Dad looked at me expectantly. The child was limp, his arms and legs just dangled, his head hung over his mom’s arm. “He has been so sick! He hasn’t eaten or had anything to drink all day. We are so worried.” The child didn’t move. I panicked.

“I’ll be right back,” I told them and got my preceptor. “This kid is really sick! He just lays there, he is pale and looks terrible.” My preceptor asked me “Did you try to wake him up?”……….Oh………..Duh.

Needless to say, I went back in and asked mom to put the child on the table. He woke right up and was actually fine. Had a simple strep throat. I felt pretty stupid. My preceptor is an angel, she did not say a word, didn’t even smirk. I love her.

I poke them a bit before panicking now.

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