Post-Test Relief

Just wanted to give everyone an update: I passed the national certification test this month!

Now the job search begins...

I hope everyone is having a great summer. Mine has been extremely busy, but I still plan on keeping up with this blog as much as possible.

Peace.

Pre-Nurse Practitioner Certification Exam Anxiety

In less than a month I will take the national certification exam for family nurse practitioners. Similar to law school grads who experience a certain discontent at graduation with the summer Bar exam looming over their heads, my own graduation was a bit marred with the anxiety of my upcoming exam.

Basically, until I pass that exam and am licensed to practice, my nurse practitioner degree is meaningless. While excited that I was nearly done with school, I started studying for this exam while in the midst of finals.

Today, I also ran into a really cool blog written by a family nurse practitioner in New York, while looking for ways to assuage my pre-exam anxiety. It is a relevant, interesting blog, and one that I plan on keeping up with while beginning my own career as a family nurse practitioner.

I would like to detail my own experience while studying for the NP certification exam. Hopefully in months or years to come, other soon-to-be NPs will stumble upon this and find some solace that they are not alone in what they are going through.

Oh, and hopefully I pass.

1. I, many times a day, alternate between being convinced I am way too stupid and not prepared and am going to fail the exam, and being convinced I am a genius who probably doesn't really need to be studying at all.

Until I get to questions like:

"Actinic keratosis can be described as:

A. a slightly rough, pink or flesh-colored lesion in a sun-exposed area.
B. a well-defined, slightly raised, red scaly plaque in a skin-fold.
C. a blistering lesion along a dermatome.
D. a crusting lesion along flexor aspects of the fingers."

(The correct answer is A.)

2. Along that same vein, I am also convinced that when I start practicing, I will either be the best nurse practitioner ever and all my patients will love me, or I will kill my first several patients and be sued and lose my license within the first couple weeks.

Let's hope it's the former.

3. Within a couple months, I will be unleashed into the real world and expected to be able to accurately diagnose, manage, and treat lots of weird diseases out there.
People will walk into my office one day soon and expect me to know what things like neurofibromatosis, thalassemia, and hand, foot, and mouth disease are.

While I may or may not always have an MD or more experienced NP around to help guide me through my first year or two in my new career, the thought of all of this is overwhelming and scary. Am I ready?

Well, I better be soon.

4. I really, really hope my test is full of questions about STDs, HIV, and upper respiratory symptoms.


5. I have an unabashed admiration, bordering on a crush, on Margaret Fitzgerald, her review book, her courses, and her mnemonics. I will never forget the cranial nerves again.

6. Until I take this test, I have free reign to drink as much as I want. And afterwards, of course, in celebration. Or sorrow.

That's all. I guess I should study now.

Stolen Lines #2

"Tell me... have you ever thought...of
changing your life?"


I asked the Vietnam veteran corner store clerk as I
picked up the daily newspaper on my lunch break one overcast
November day. It was a day just like 100 previous
days: I woke up at 7 o'clock, drove the 45 minutes to
Bloomington after lugging myself out of my dad's
pull-out couch in the basement, parked in the drab, concrete
parking garage, and walked up the hill to the tiny law firm
where I was a secretary for a lone practicing
attorney.

It was a day just like the 100 previous work days that
I sat transcribing my perverted boss' lawyerly notes
into his beaten-down Mac computer, answered ridiculous,
angry phone calls from bitter divorcees for the upstairs
attorney, got bitched at for not bring their faxes upstairs
quickly enough, and wasted a perfectly good college
education and year of law school on a pointless $10 an hour
job with no chance of upward mobility.

It was a day, like every other day that would come for
the next year, in which I desperately wanted something more
yet could only muster up the ambitiousness to look forward
to each Friday's happy hour at the corner bar, finding
solace in the next round of Blue Moons and pretending I was
okay with where and how I had ended up for the rest of my
life.

"I hate to be the bearer of bad news, but
your entire left cheek is showing."

Said the Vietnam vet. I don't even know if
he had been in Vietnam or was even a veteran,
but he smoked cigarettes in his shop, had a limp and a plethora of
American flag t-shirts, and wore his black-gray
hair in a ponytail. We chatted amicably like this
every day for the past 100 days. I really enjoyed our
shared apathy and friendliness, we bonded nearly every day over cokes
and central Illinois' most "pressing" news of the
day. Then I would walk to lunch and pore over the
classified's, hoping to find that one
lucrative career for an English major/law-school
drop-out within 30 miles of my hometown.

"Wait, what?!"

"Your entire left cheek. It's
showing. You have a rip in the back of your pants. I
thought I should tell you."

I turned around and there it was, in plain sight for
all of downtown Bloomington to see. What had
happened?

I froze, I panicked. I did the only
thing I could think of and asked the Vietnam veteran, with his
years of hard-core military experience and living a hard
life. He would know what to do.

"Well? What the hell do I do?! And of all the days to wear a thong!"

He's been through war. This is nothing to him.

Calmly, he answered.

"There's a seamstress next door.
She may be able to help you. Good
luck."

Though the sign said, "By appointment only,"
I walked into the drab building directly across from the law
firm at which I worked, and pleaded my case to The
Seamstress.

Suddenly, everything in my life depended on
the whim of this all-powerful Seamstress, and her needle and
thread. My fate was in her hands for the next 30
minutes.

"I live 45 minutes away. I've got an hour for lunch, please fix my pants."

I sat pantless in the dressing room on that gray
November day that wasn't like the 100 previous days,
reading an oversized book of horoscopes for the next 30
minutes while The Seamstress sewed my pants back together:
"The Sun, ruler of our inner nature, is somewhat
dimmed in Cancer, the home of the Moon. Creative and
romantic, with a strong love of home, family and tradition,
you are a good communicator and a strong provider. Your deep
sensitivity presents you with valuable and illuminating
intuitions, especially regarding those you care
for."

Well, I never felt as if I was reading something more
inaccurate about my life at the very moment.

I left The Seamstress after repeated failed attempts
to pay her for mending my pants and grabbed a quick goulash
at the Pub down the street, silently reading my newspaper
picked up from the Vietnam vet's corner store.


I trudged back to work, transcribed more lawyerly notes
from my perverted boss, answered ridiculous, angry
phone calls from bitter divorcees, got bitched at for not
bringing the faxes upstairs quickly enough, checked my email
and make plans for happy hour on Friday. At 5
o'clock, I walked down the hill into the drab, concrete
parking garage and made the 45 minute drive home.

I parked my little car behind my dad's over-sized Man Truck and walk inside, weighing my desire to make people laugh against my embarrassment
at the day's events, when something caught my eye.

On the kitchen table in my dad's green one-bedroom
house, next to the Hamburger Helper (three-cheese special)
and slices of white bread with butter, my dad's favorite
meal that year, was a large white envelope addressed to
me.

"We are pleased to inform you that you have
been accepted into the Nursing Program for the Fall 2004
Quarter."

I signed the letter, informing the school I would be
attending classes in the Fall, and put the envelope back in
the mailbox. I went downstairs, pulled my bed from the
couch, had another meaningless conversation over
the phone with my girlfriend in a relationship that was
headed nowhere fast, and fell asleep to the tv. I
woke up at 7 o'clock, drove to work, parked in the gray,
drab parking garage and walked up the hill to the tiny
lawyer's office where I worked for the next 200
days.

My last day on the job, I walk into the Vietnam
Vet's corner store, and inform him I am leaving
town. We laugh at the pair of mended pants I am
wearing, and we say our good-byes. He gives me a
newspaper for free, and this time I read it without
searching the classifieds as I eat my goulash at the the Pub
further up the hill.

I walk to The Seamstress' store and leave a small
check on her desk, thanking her for helping me out The Day
My Left Cheek Was Showing. I grudgingly have a beer
after work with my perverted boss and drive home as soon as
I can politely get away, to enjoy one last happy hour with
my friends.

I buy the next round of Miller Lites at our favorite
bar, laughing and hugging my friends. Newly
single, I scan the crowd unsuccessfully for traces of
another lesbian. The band is loud, but the music is
good. We are drunk and happy to be together, next
Monday is miles away. They want to know why I am
leaving our town, our bar, our beer, and our fun.


In my mind I don't hesitate. I think
of my stagnant, dead-end relationship,
transcribing lawyerly messages for my perverted boss, the
rip in my pants, the Vietnam Vet, The Seamstress, the
angry messages from bitter divorcees, the plain gray parking
garage, the hill, and getting bitched at for
not bringing the faxes upstairs quickly
enough.

I take a swig of my beer, not wanting to seem eager to leave them behind, and
answer.

"Tell me... have you ever thought...of changing your life?"


(The first line was stolen from the play, Betrayal, by
Harold Pinter. This is also part of Grace's Stolen Lines series.)

Lesbians and HIV

Rachel Rabkin Pechman's June 2009 article in Poz, entitled, "The L+ Word" gives a nice synopsis into an often unnamed, unheard-of, and un-epidemiologized segment of the population: that of the HIV positive lesbian.

Given my recent accidental occupational needlestick, I became hyperaware of this issue as I was waiting for my own HIV results.

Sadly, even I in the LGBT healthcare field had not really thought about lesbians who are living with HIV. While the percentage of lesbians living with HIV is likely much lower than that of gay males and much of the heterosexual population, they do exist. Lesbians, like any other group of people, cross and re-cross the pre-determined boundaries and categories set by epidemiologists. As with everyone else, lesbians can be infected through IV drug use, sex with men, and even sex with other women (though a definite documented case is yet to exist).

What I think is most important from a health-care provider perspective is knowing what to ask patients, and what to tell them in regards to safer sex. Mainly, never assume someone's sexuality without first asking them who their sexual partners are. After that, it becomes easier to tailor education to the patient, based on those sexual practices, and what is safest and most relevant to them.

Which brings me to the next point, if you are NOT being asked by your health-care provider who your sexual partners are, it's time for a further discussion with her, or to switch to someone you do feel more comfortable with. Health-care, as we all know, is very costly right now, even to those lucky enough to have insurance. And, most importantly, you're stuck with your body your entire life. We all deserve to be treated safely, and with dignity and respect by our health-care providers.

Stolen Lines

Feeling both empowered and terrified as I drove into work, I looked up at the sky and started talking.

I can't believe I did it. I asked for the test, calmly entered the orders myself into my chart, sat while the blood was drawn from my arm, dark red wine after a painless little pop of the vein, cracked jokes with my favorite medical assistant while she offered me kind words of assurance and nervously drew the blood. Gloves clear with sweat. Laughing and hoping, worried, I went about my day.

Suffering ends when craving ends. When one is freed from desire.

I did this on my own. I can do anything on my own.

But taking the time, being brave enough to face my fears, that is empowering. Sure, my test is probably negative. Sure the chances are like 1 in 10,000. But knowing my luck as of late, nothing, absolutely nothing, would surprise me. And so what if it is, I'll join a convent of lesbian nurses. I'll go on a spiritual retreat. I will forgo alcohol, cigarettes, coffee, sex. After all, it's always best to be prepared, have a back-up plan for everything. A chuckle forms at my lips, thinking of how I am going to tell all my friends about how scared I am. How scared I was, when really there is nothing to be scared of at all.

"You'll be fine, dawg, I know it," they all said.

If three months ago I had accidentally plunged a large-bore hollow needle into my thumb after injecting it into an HIV+ person, I would be scared shitless.

Three months of hoping and waiting.
One month of medications, really it's nothing in relative terms.
Three days of testing.
One day off of work.
A milli-second mistake.
For some people, it's life. And they are okay with it.
Maybe one day, I would be, too.

Life as we know it ultimately leads to suffering in one way or another.

I start to cry, imagining just how I am going to break the news to my friends, my family. I can see it now, "Jane, you have to come in to get your results." That is never good news. Co-workers, friends, acquaintances, all with that same look in their eyes. Pity. The same look I have given patients so many times, when delivering the news that forever alters the courses of their lives. There is no way to really make it better. For myself, for them.

I collect myself, and call a friend. Several minutes of reassurance and going back and forth, I convince her to let me check my results on my own.

I don't want to put you in that awkward place of giving me a positive result.

Click.

And a few more clicks on my keyboard.

Crescendo.

Result not back yet.

Decrescendo.

What does that mean? It's been 24 hours. Negative results are always back in 24 hours. Well, it's been 21 hours. Why is it not back yet? It must be positive. Maybe it's, what if it's positive? I start crying. Should I go for a run? Yes, I'll go for a run. 30 minutes gone by, and I will look again. Surely they will be back by then. Maybe the lab isn't open yet. Maybe they went for their morning coffee run. Maybe each and every one of the protein markers is slowly turning positive. Ooh, this episode of "Charmed" is funny today. Prue turned herself into a man to entice this witch-lady who only goes after men, and she totally pulls off drag. Maybe she's gay. Oh my God, what if Shannen Doherty were gay? Maybe I should look again one more time before my run. Maybe I should finish watching the episode and laugh one last time in my life, then check my results. Wow, is that her real voice? It's so deep. I bet she watched drag-king shows in preparation for this episode. She's a much better actress than people give her credit for.

Episode over.

I walk to my computer and, crying, log in to my chart. Result back, unsigned. No one else has seen it yet.

Non-reactive.

Negative. I tested negative.

I check again, just to be certain there is no mistake.

Non-reactive.

The doctrine further asserts that because things are impermanent, attachment to them is futile and leads to suffering

Crescendo.

I start crying. I walk to my bedroom in silence, slip on my running clothes, turn on my i-pod, and go for a jog. 30 minutes later, I get home, take a shower, and get dressed. I text message friends and let them know, thanking them for being so kind and supportive.

Decrescendo.

I slip on my white coat, stethoscope folded in my hands, I get in my car.

Feeling both empowered and terrified as I drove into work, I looked up at the sky and started talking.


(Note: this is part of Grace's "Stolen Lines" series)

Update #2

Hello everyone and anyone who may still read my blog. (thanks if you still do, by the way).
I feel that I owe you another update on my recent HIV scare 3 months ago. I just got my 3-month re-test yesterday, checked my results this morning, and they were negative.
It was a huge relief.
Thank you to call who have wished my well, held their collective breaths, and said their prayers to whichever gods and goddesses you worship. I feel like I can finally start to put this nightmare behind me.
I expect to be up and blogging again shortly. School is almost out, the weather has turned beautiful, and I have started to deal with a lot of my stressors in positive ways.
More to come!

Update

I am sorry for waiting so long to provide an update on my prior article.
As of now, all of my HIV and hepatitis tests have been negative. Good news!

I will be re-tested again in about a month, and that will be an almost definite guarantee that I will not seroconvert.

I do appreciate all of your thoughts and wishes, JHG, Fannie, Antigone, Seda, REM... Thank you so much. It has been a trying and stressful couple of months, and I am relieved it is nearly over. I hope everyone is doing well, and I will be back in the blogosphere soon.

My HIV Scare

I haven't posted for a while. I am sorry. In the midst of the usual work-study-school cycle that I have endured for the past 2 years, I have also been dealing with something else.

So, this will be a break from the usual political or health-themed articles I have been writing. Basically, I am scared, and I haven't told many people even in real life.

But this is my relatively anonymous blog, where only a few people really know who I am. In my own way, this is my therapy.

Without being too specific, within the past 2 weeks I accidentally stuck myself with a used needle while doing my nursing duties.

The needle had caused the patient to bleed. I am not sure if or how much blood was on it.
The needle was relatively large and hollow-bored.
While fumbling with the so-called "safety" mechanism on the needle, the syringe slipped from my hand and while trying to catch it, my thumb penetrated the used needle. I should have just let it drop to the floor, I suppose.
Within seconds I was also bleeding from inside my glove.

The source was an HIV-positive person.

I suppose everyone at some point in their lives has a moment like this. An accident. A diagnosis. The death of someone close. One single moment that you soon realize will determine the course of the rest of your life.

I can only describe the way I felt when it happened as a wave of nausea accompanied by visions of everything that led up to this moment, everything I had worked for, and everything that one little mistake might mean for the rest of my life.

Realistically, the chances of health-care professionals' seroconversion when exposed to HIV are around 0.3%, per the CDC. I know the odds are in my favor. But the chances are never zero. And just knowing that I was definitely exposed in a real way to something is not good for my hypochondriac soul.

Within a couple seconds I was hovered over the sink, washing my thumb with hot water and soap (also squeezing it like a snakebite, as if that would actually help), while calmly letting the patient know what had happened.

I am also in the midst of completing a rather hellish course of PEP (Post-Exposure Prophylaxis), which for me is 4 different HIV medications...which can have both annoying and serious side effects themselves. The purpose of the PEP therapy, based on what is known about the pathogenesis of the HIV virus, is to prevent systemic infection by introducing anti-retrovirals within the 24-72 hour period it takes for the virus to infect regional lymph nodes at the site of innoculation. Basically, the medications I am taking, we hope, would prevent any replication of any theoretial virus or virus-containing cells that may have entered my body. Of course, studies in humans for this are rather limited for obvious reasons (ie-thousands of health-care workers who were exposed would have to enroll in an efficacy trial), but the limited animal and human studies that have been analyzed have shown an 81% reduction in HIV seroconversion following a 4-week course of PEP.

I'm trying to keep a good outlook on things.

I will be re-tested in a couple weeks. I may or may not ever write another post about this again.

Just thought I would share my story.

Peace.

Christians for Equality

I just found the following wonderful new blog, called Christians for Equality.

It looks like the author is attempting to counter the widespread tendency of anti-gay folks to mis-represent themselves as "victims." Well, and not only that, she is showing that (obviously) Christians can be for gay rights and equality. I am sure we all knew that, but it seems like the squeaky wheels of the Christians always get the most grease. This looks like it could be a refreshing new blog.

Her post today, for example, is a youtube clip featuring "Christian-bashing" vs. (the very real) gay-bashing.
Please check it out.

Sabbatical

Sorry for the long delay and for not checking in. The school year picked up again after the New Year, and I've been busier than ever. These last 5 months are the home stretch and I won't get much time to write until then. I'll stop by every now and again, and I'll still be reading other blogs.
I just have to devote more of my energy to school right now, instead of writing for fun.
I'll be around...

Until then, enjoy.

Well-wishes for Patrick Swayze

Today, I am sending out some positive energy to Patrick Swayze and family, in hopes of a speedy recovery from pneumonia, a likely complication of a chemotherapy-weakened immune system from his year-long battle with pancreatic cancer. Swayze checked himself into a hospital on Friday, just 2 days after his Barbara Walters' interview aired on ABC.

Swayze has been one of my favorite actors since the classics Dirty Dancing and Ghost. And he is pretty foxy, too.

I wish him the best.

Ellen thanks "roommate" Portia at People's Choice Awards

Kudos to Ellen Degeneres.

Not only is she one of the funniest, most positive comedians out there these days, she won a People's Choice Award for "favorite talk show host" again last night.

Keeping up with her trend of becoming more outspoken about LGBT rights, at the end of her acceptance speech, she thanked her "roommate" (wife) Portia de Rossi, an obvious note of sarcasm directed towards the recent passage of Proposition 8 in CA.

*sigh*

I heart her even more.

The editor of one of the best lesbian websites I have found, Sarah Warn, also writes about it here.

Blogging for Lesbian Health Day

Today's article is part of "Blog for Lesbian Health Day," which was started by organizers of the National Lesbian Health Summit 2009. Back in December, I was approached by an organizer and asked to write about issues that affect me in all or some of those roles within the overall health-care experience. More specifically, I was asked about my personal health-care experiences as a lesbian, and also what issues I am concerned about for myself and community.

So, without further ado, here are my individual thoughts and experiences. As a patient and a nurse. And always, as a lesbian:

The first and most obvious issue of concern regarding lesbian health revolves around lesbian sexual health. A term within the (LBT-knowledgeable) health-care community is "lesbian neglect." Lesbian neglect refers to the fact that many lesbians fail to get Pap smears, do not get them regularily, and/or do not think they need to get them.

Dr. Jeanne Marrazzo of the University of Washington has published several reports on the sexual health of sexual minority women. In one, she discusses barriers to infectious disease care among lesbians. For one, there is relatively little data on STIs, Pap smear screening, and cervical dysplasia among lesbians, all of which are needed to make clinical guidelines for lesbians. Secondly, health-care providers and lay-people commonly assume that a.) sex between women confers virtually no risk, or b.) it is at the bottom of a hierarchy of higher-risk behaviors. However, transmission of HPV, syphilis, and HIV between women have been reported. All of that being said, it is important to reiterate that virtually no data exists of the relative risk of STD transmission in same-gender sex among women.

Of the data that exists, it does show that lesbian neglect is a fair portrayal in regards to lesbians and Pap smears. In the Marrazzo articled previously mentioned, 95% (236) of lesbians in one study believed they should receive Pap smears annually or every 2 years after normal results, yet 36% (90) provided a reason for not having done so. The most commonly cited reasons were "lack of health insurance, adverse experience at prior Pap smear screening, and a belief they did not need it because they were not sexually active with men."

Sadly, 9 of the women reported being told by their health-care provider that they did not need a Pap smear since they did not have sex with men. As an FYI, Marraazzo and other LBT-knowledgeable health-care providers recommend that lesbians follow the same cervical cancer screening guidelines as all women.

Per the American Cancer Society that means that women should begin getting a Pap within 3 years of their first sexual activity, and no later than age 21 for women sexually active after the age of 18. For all of the recommendations, please go here.

Pap smears and lesbian neglect hit close to home for me. I received my first one at the tender age of 26, when I finally had health insurance...and, when I got over my case of lesbian neglect. It was quick and relatively painless. My doctor had been practicing for 30 years or so, and I didn't feel uncomfortable. She also did a sexual history, inquired about the gender of my sexual partners, and provided non-judgmental care. She was nice. But she wasn't LBT knowledgeable. At the end of my visit, she came back to my exam room and told me that since I didn't sleep with men, I didn't need another Pap, ever.

Needless to say, even though she was nice and the procedure was painless, I never went back to her. Everyone deserves culturally competent care, and sexual orientation should always be a part of that competence and knowledge base.

That is my one major advice to lesbians (and any sexual minority): You have the right to be treated compassionately, non-judgmentally, and competently. You also should always be given the change to disclose your orientation or identity in a non-awkward manner. A health-care provider should never just assume you are heterosexual without first asking you who your partners are.

Which brings me to my other point, the one major issue I would LOVE to see incorporated into nursing schools and med schools is sexual minority health.

I graduated from nursing school within the past 5 years, so I know that the lack of education on sexual minorities we received is not a matter of time-appropriateness.

The one time in my nursing school program that lesbian health was even mentioned was when my professor stated, "Lesbian and bisexual women will have...other... concerns, but we aren't going to discuss those today" before venturing to the next nursing school topic du jour. (because we ALL need yet another lecture on HIPPA or standard precautions)

I was forced with a milli-second decision on whether I was going to risk outing myself (by virtue of guilt-by-association) to a class that considered it somewhat okay to make fun of gays and lesbians occasionally, or sit there and silently wonder to myself just what these "other" issues unique to lesbians were.

In retrospect, and having since come out to my nursing school and classmates, I should have raised my hand and demanded a further explanation. A discussion, at the very least. But that didn't happen at the time. And thus, none of my classmates nor I ever received education on lesbian health.

Instead, I chose to go into the field of LGBT healthcare following graduation from nursing school. I take part in any related continuing education courses offered by organizations in my area. However, my education on LGBT healthcare is taught to me, 9 out of 10 times, by my colleagues and patients. Sometimes it feels like we are making it up as we go. But usually there is someone more senior, more knowledgeable, and with more experience we can go to. I am thankful that the tide seems to be turning in regards to lesbian health awareness.

There are, of course, other health issues that occur more often in lesbians (like smoking, depression, obesity, etc.) that I believe definitely need more attention. Our little community is, I believe, doing a decent job of addressing these issues.

And thanks to the groundbreaking work of people like Dr. Marrazzo and others who study sexual minority women, and the National Lesbian Health Summit, we can all look forward to a day in the near future when it is no longer taken for granted that all women are either heterosexual or have no health issues.

To a day that lesbian health is deemed a worthy topic in nursing and medical schools.

And most importantly, to a day that lesbians are included in national guidelines relating to "women's health" and not simply overlooked as unimportant or (mistakenly) without risk.

After all, we are women, too.



Reference

Marrazzo JM. Barriers to infectious disease care among lesbians. Emerg Infect Dis [serial on the Internet]. 2004 Nov [retrieved on 1/5/09]. Available from http://www.cdc.gov/ncidod/EID/vol10no11/04-0467.htm