Spring

The robins are back, and the red winged blackbirds. The red maples are budding, and though we've had flakes of snow every day this week, when I go out to run I can smell the ground waking up. There are hundreds and hundreds of geese in the air. The sky is thick with them. But amidst all those black bodies, one day I saw a flash of white and wondered what it was. On the ride home, I saw them resting in a field -- seven swans on their trip north.

the tricks work so far...

One of the tough things about being a new NP is worrying about my physical assessment skills. More precisely worrying that I'll miss something important. Part two of that worry is wondering whether I'll know how to manage a situation appropriately if I do find something.

During the conference I went to in Boston, I went to a session on fine-tuning assessment skills where the instructor promised that if we followed her techniques we would feel things (say, ovaries) more often, we'd be more precise in our descriptions of what we were feeling, and our patients would be happier with us too (no more mining for a cervix with the speculum).

Friday I had someone come in with right adnexal pain and some funny bleeding. So I collected myself and mentally went over some of the things the instructor wanted us to do, and I found a 4 cm (about) tender mass on/near(? not sure which) her right ovary. Now chances are this was just a cyst, but it kinda freaked me out anyway. I hopped out of the room, did a quick huddle with the other NP working with me, and we decided to send her to the ER. If it was a cyst, and it ruptured over the weekend, she could be in a lot more pain. At the ER they'd be able to do ultrasound and find out exactly what it was, and give her some serious pain meds. Pretty sure it wasn't an ectopic, because her PT was negative. The other NP was going to call her Saturday and see what happened -- I can't wait to find out.

The very next patient, while I was doing her history said that sometimes she had some dull abdominal pressure/pain. She said she'd had an ultrasound and they found some "spots" on her uterus "that could make it tip" and she was supposed to have another ultrasound but she hadn't done it yet. OK, so what could this be about? I started doing her bimanual exam and the lightbulb went on -- "did they say you had fibroids?" Why, yes! And I actually could feel it... wow. Most of my patients are 16 - 25 year old young women, not too many of them have fibroids, so I hadn't actually felt any since I was in clinical back in 2003. I'm going to have to write a letter to the instructor of that session...

Yesterday, I drove all over creation again. I went to a citizens hearing for HR bill 676 -- John Conyers universal health care bill. Much more on this to come.

Boy, I wish I still lived here...

I'm in the Boston area for a conference on women's health this week. The conference is at the Sheraton, right at the foot of the Prudential center, but today I took the train in all the way to South Station, then hoofed it up through Downtown Crossing, up past Beacon Hill where I used to work, through the common and the public garden of swan boat fame (and saw the first robin of spring, perched in a crabapple tree), and all the way down Newbury Street -- got to my conference just 5 minutes late.

On my lunch break I headed west out of the Back Bay into the Fenway -- I wanted to check out the Isabella Stewart Gardner museum, since I'd never managed to get there while I lived here. I almost didn't go back to the conference. Forget the art, I could have just spent the whole time sitting by the courtyard. But I went exploring, up to the second floor, around a corner, and found myself face-to-face with the 23 year-old Rembrandt. I was floored.

And they had a Bellini exhibit, with some really cool pen and ink drawings. And Mrs. Gardner apparently had a typical victorian fascination with the far east. Lots of lovely Japanese panels and screens to see.

At the end of the day, I was dragging my now pretty sore feet to the train station when someone passing by asked me for directions! Ha ha, I still look like I know my way around the place.