[NP-Clinical] Need help

[stephanie2u at optonline.net]

Just my own take on it:
Bottom line: Ask your boss to handle it, and between you decide how to choreograph it: both go in together, introduce your boss and explain she's better qualified to go over the results, and she can say that she knows it can be difficult when a health professional has a friend for a patient--whatever, you get the drift. Find out ahead of time what she is going to tell them so if they need privacy, then you be able to talk with your friend about it later.

Why:
It sounds like the diagnosis is not 100% certain--that he needs confirmatory studies. Even if there is the least little bit of uncertainty, it might be better if someone can talk with him who can be completely detached and unemotional. What if it turned out to be a false alarm? (Granted it doesn't sound very likely.)

For that reason your boss would probably be the better one to discuss the possible implications of the results.  I don't think it would be helpful for your friend if you were to lose your composure at this stage. Just MHO.

How very difficult this must be! I hope it's a false alarm.

Stephanie Walker, FNP

----- Original Message -----
From: Julie Orfirer 
Date: Thursday, May 10, 2007 10:17 am
Subject: [NP-Clinical] Need help
To: np-clinical at nurse.net

> So, this is why you aren't supposed to see your friends as patients.
> 
> My husband's best friend, our best man at our wedding, was 
> over a few weeks ago and said he was diagnosed with osteoporosis 
> but had to wait several months to get an appointment with the 
> endo that his doc suggested he see. I said, well, you can come 
> to our office and figured he'd see someone else in the office 
> and not me (due to being a friend and some recent personal 
> issues that were sort of between the two of us - way too 
> complicated to discuss). But, there he was on my schedule. I 
> figured, what could go wrong? So I did all the routine stuff 
> and included a monoclonal protein study which I do for just 
> about anyone in their 60's and he had had prostate cancer 2 
> years ago.
> 
> Just got the report back. Bad news. He has an "M-spike in 
> gamma region", "monclonal IgG kappa C/W MGUS, early myeloma, 
> amyloidosis, etc". I admit that I don't really have a clue 
> whtat all that means chemically but I know what it means 
> clinically. In fact, just had my first case of multiple myeloma 
> yesterday - got the report from the heme/onc of another man who 
> had the same results - his x-rays look terrible. So that's why 
> I'm so running to that conclusion.
> 
> He has an appointment for next week - I don't know what to do. 
> I don't know if I can tell him about this or if I should or if 
> I should switch him to my boss's schedule or see him together 
> with her or what. I don't know how to keep this a secret from 
> my husband until then. I was just telling him last night about 
> my other patient whose x-rays were filled with lytic metastatic 
> lesions. I'm really torn up. (Just drying my eyes now from 
> reading the report.) His 70th birthday is in a month. I know 
> that people live well for a long time with MM. But....
> 
> Would appreciate anyone's opinions, advice.
> 
> Julie
> 
> 
> “To affect the quality of the day, that is the highest of the 
> arts.” – Henry David Thoreau
> http://sculpturefest.org/pages/artists2006/markey.html
> 
> ---------------------------------
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> Check outnew cars at Yahoo! Autos.
> 
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