Gracias

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A few things I’m thankful for on a rainy, windy Thanksgiving eve:

Bacon

Rhinestones and glitter, for making the world a little brighter (what with all that additional light they reflect into our eyes)

My daughter’s unyielding commitment to the concept of spending the evening hanging from our ceiling in a climbing harness

Our annual Thanksgiving viewing of Anchorman: the Legend of Ron Burgundy

Warm sweet baked goods a la mode – always, always a la mode

The snooze button

Pre-holiday clinic days, when most students have left behind the health center staff with enough free time to spend the afternoon watching music videos from the ’90s and online shopping

Movie musicals

Coffee with flavored creamer, for turning a necessary chore into morning dessert

Squirrels

Footie pajamas

Thanksgiving is seriously the best, right? Just keep in mind: be sure to overeat right up to the point of moderate gastrointestinal distress but not beyond, limit yourself to no more than two uncomfortably passionate discussions about politics with your aunt’s husband, and hug your loved ones at the end of the night.

A lot.

Enjoy.

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#AbxScore

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I stumbled across an article circulating around the twitterverse today – the comfortingly titled “Antibiotic Resistance Will Mean the End of Just About Everything As We Know It” – and I was left with a gnawing unease about my antibiotic prescribing habits.

Until now, I think I’ve tended to cut myself too much slack. I’m already SO much more conservative with prescribing than other providers I work with – so the story I tell myself goes – and most definitely moreso than these patients’ providers back at home who prescribe successive Z-packs over the phone from 3 states away, right? And don’t get me started on antibiotics being available over-the-counter everywhere else in the world. So really, if a particularly insistent patient comes to see me and presents some halfway decent story about their miserable and worsening nasal congestion, am I the absolute worst person in the world if I cave from time to time?

The danger of this line of thinking is the same pattern that led me to gain back half my baby weight in the 2 years after kid #1 was born, one delicious pastry at a time. If one ice cream sandwich is good, two is better, right? And it’d be a serious tragedy if the remnants of that fettucine alfredo was just thrown away LIKE TRASH simply because no one was courageous enough to finish it off.

But after a particularly contentious meeting with a clinic scale, I decided to make a change. I downloaded one of those calorie-counting apps, where it calculates your daily caloric limit, and then you enter every bite of nutrition that passes your lips. Super fun time! But seriously, IT WORKED. It kept me honest. Before grabbing justonemorecookie, I’d think about how I’d have to enter it into this dumb little app, and see the number of cookies consumed staring me in the face. Blergh. Somehow the cookie didn’t look so irresistible anymore.

So I’m just kicking this idea around here, but what if we all (we all = MDs/DOs/NPs/PAs working in primary care, urgent care, retail clinics, etc) started doing the same thing with our antibiotic prescribing?

It could be like a game. I hear these hashtag things are popular, right? So what if we started posting our daily #AntibioticScore? And by score I mean numeric value, as well as SCORE! Yeah, brah!

Actually, #AntibioticScore is kind of long. And my fingers trip up over all the i’s and the t’s and whatnot. So let’s abbreviate, shall we?

#AbxScore = # of questionable antibiotic prescriptions NOT given due to spectacular patient-centered education and counseling / total # of questionable antibiotic prescriptions possible.

Today, I saw 3 patients with vague-ish URI symptoms who were here for – let’s face it – antibiotics. At the end of each visit, they all left agreeing with me that they really didn’t need antibiotics after all. So today’s score would be 3/3, or 100%! GO ME. (It is likely not a coincidence that today is the day I decided to start tracking myself. It’s like deciding you’re going to commit to wearing that FitBit the day that you happen to go hiking and kickboxing and cycling, all in one exhausting 24-hour period.)

Now, your daily #AbxScore doesn’t include legitimate antibiotic prescriptions. I also saw two cases of strep throat, and one patient with a UTI, but these don’t get included in my #AbxScore because, um, they clearly needed antibiotics. I get that there are plenty of real, valid indications for antibiotics. I’m not insane, people.

But if you’re even thinking about using the diagnosis code for an undifferentiated “upper respiratory infection (URI)” at the end of your note – even if you’re more likely to enter the more specific-sounding “sinusitis” or “bronchitis” to feel justified about giving that Augmentin rx – that visit gets entered into the #AbxScore. Which you then post on Facebook or Twitter or your bulletin board at home or whatever, allowing your peers (or children, or pet ferret, or you looking back at yourself in the mirror) to congratulate you on your spectacular antibiotic stewardship.

Now, this is honor system only, obvs. Especially because there’s, um, no actual prize. Except of course SAVING THE WORLD FROM A POST-ANTIBIOTIC FUTURE. (One self-resolving cold at a time.)

Who’s with me?

Redefining success

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Yesterday, I posted a response to an article in Cosmo that bugged me. I posted it here, on my little blog, the one whose most loyal reader is my mom. (Hi Mom!) Then I went on my way.

I had the day off, so I had a girl date scheduled: mani/pedi followed by lunch and maybe a grown-up drink. Of course, when you have a baby in tow, girl time looks a little different – 15 minutes late, I blustered into the nail spa’s oasis of zen, stroller and diaper bag overflowing. Other midday mani customers (a niche demo if there ever was one; I observed several unique examples of leopard print) looked up at me and gave the side-eye. Yeah, yeah. Back to your nails, ladies.

I settled in and glanced at my phone. Notification from WordPress: “Your stats are booming! Looks like Love and Ladybits is getting lots of traffic.” Huh. That’s weird. But good? I guess?

By the time our visit to the nail spa had come to an end, the baby had charmed the pants off every leopard print aficionado in the place, my fresh manicure was already completely trashed from fumbling around in the diaper bag for random objects to be used as baby toys, and my morning diet of coffee followed by more coffee plus polish fumes was starting to make me woozy. We headed off toward lunch and I glanced at my phone again. It appears that my blog is getting comments! And people are tweeting about (at? still unclear) me! But being the good girlfriend that I am, the phone was stowed away until the final bite of birthday brownie had been consumed.

And then I started reading the comments.

Look, people. I just started this thing because it’s cheaper than therapy. Earlier this week, I talked about my (highly questionable) decision to eat leftover cake out of the trash. Then I blogged about my (highly questionable) decision to read Fifty Shades of Grey. I’m not pretending to be WebMD, or even Cosmo. Yes, I’m a health care provider, but I’m also a human being, and I’m entitled to have human opinions and human emotional responses like everyone else. So when I read something I disagree with, I’m allowed to respond however I want.

It’s kind of like that time when I was 22 and my pill was changed on me for some obscure HMO-related reason. I didn’t love the way the new pill made me feel, so I asked the doctor with the soonest available appointment to change it back. He refused, and gave me a prescription for Prozac instead. Nice.

Did I complain about it? HELL YES. It also taught me a few lessons about the type of provider I hoped to become someday. And I haven’t stopped complaining, and learning from the things I complain about.

The irony of my being called the many, many names thrown at me over the past 24 hours is that I’m actually one of the most patient-centered care providers I know. I practiced shared decision making before it had a name. I have a comprehensive list of hormonal and nonhormonal contraceptive methods that I review with everyone, even the patients who come to see me specifically to start the pill. And when a patient asks to change her method because she doesn’t love it, we work on it together until we find something better for her.

That might be because I still remember exactly what it felt like to be a college student. I felt like I knew everything and nothing, often at the same time. I’d start a feminist activism group on campus, and then miss entire weeks of class because MTV decided to run a Real World marathon. I had fierce convictions and boundless potential but not always the best follow-through.

I see that in my patients, and I get it. It’s part of why I love this population, and part of what drives me crazy about it, and all of it is 100% developmentally appropriate. Telling an 18-year-old who’s barely figured out how to use a tampon to check her cervical mucus is asking a lot. Expecting someone who doesn’t own a thermometer and doesn’t know what a fever feels like yet to reliably monitor her basal body temp is asking a lot. I’m not saying fertility awareness methods are impossible for the informed and highly motivated teenager, but it may not be right for every teenager. It certainly wouldn’t have been right for me.

And isn’t that the awesome thing about being a woman of reproductive age today? We have choices! Lots of them! This is a good thing!

Which is why it didn’t occur to me that writing a pro-pill (but really more of an anti-anti-pill) post would inspire the level of vitriol it did. I mean, if it had been coming from angry Catholics, I might have been less surprised. But it didn’t. For the record, the tone of this blog has nothing to do with tone I use with patients, and I promise that I’m not “pushing” anything…except informed choice.

Anyhow, as I get back to my role as cog in the of the woman-oppressing patriarchial/big pharma machine, I’ll sign off with the observation that I now seem to have more readers than just my mom (no offense, Mom!). And that’s certainly something.

My letter to Cosmo, or, why the Pill may not actually be “effing with your health”

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Dear Virginia Sole-Smith,

First of all, congratulations! I understand that you’re pregnant. Awesome. Buena suerte. Having been on that particular journey myself, I can say it’s always an adventure. Also, pregnancy hemorrhoids are real.

It sounds like you’re pretty thrilled about being pregnant, since in addition to bringing a new life into this world, your endometriosis is finally under control. Bonus!

Oh wait. As I understand it, your endometriosis was actually pretty well-controlled for years. Because you were taking the Pill (capital P, right?). The same Pill that you just wrote an incredibly lengthy and meandering article criticizing? Right. That one.

And here we come to the reason why I felt compelled to write you this little note. Because I came across this article, with its eye-catching title (“The Weird Way the Pill is Effing with Your Health” – ooh, they said “effing”! So edgy!) and thought, hm, I wonder what her angle will be?

See, I prescribe a lot of birth control. Sometimes (often) to prevent pregnancy, sometimes not. And for some reason, birth control pills tend to inspire passionate opinions. I prescribe plenty of other medications as well, but people don’t generally get quite as fired up over their albuterol inhaler. (Maybe they should?)

It appears as though you’re already familiar with some of the more common non-contraceptive reasons we prescribe the Pill. Which is super, because that means we have less to review! As you rightly pointed out, in addition to being used as a form of birth control, combined oral contraceptives (aka THE PILL) can be an effective means of treating a wide variety of hormone-sensitive conditions, including polycystic ovarian syndrome, menorrhagia, acne, and – your favorite and mine – endometriosis.

The thing is, the things that the Pill treats tend to be chronic conditions. Chronic meaning ongoing, maybe for years, without a clear endpoint. Like any of the above-mentioned conditions, or, you know, fertility. (No disrespect meant, fertility, but you have to admit, you can be pretty high maintenance.) We don’t typically have a CURE, per se, for chronic conditions, but often, we have things we can do that can control or otherwise reduce the severity of that condition until it (hopefully, maybe) resolves on its own.

If you strip it down to the details alone, your story almost sounds like an advertisement for birth control pills – which makes the title of the article, and the tone, a little confusing. Apparently you developed severe dysmenorrhea (painful menstrual cramps) in high school, so you went on the Pill. AND IT WORKED. And when you started having sex, you also relied on it to prevent pregnancy. AND IT WORKED.

Unfortunately, you started to experience some side effects. Nothing scary, but bothersome. So… You stopped taking the Pill. You tried some other stuff, but nothing worked as well at controlling your cramps (besides pregnancy, OBVS). Bummer.

So here we have a patient, with a chronic condition, who takes a medication to reduce the severity of her chronic condition. The medication works, but she stops taking it because of unpleasant side effects.

I think we’ve just described pretty much any person who’s ever had a chronic medical condition, ever.

When someone discontinues their metformin because they’re running to the bathroom with diarrhea all day long, do they get angry with metformin for existing? Do they grow suspicious of their provider’s hidden agenda, even if it’s completely unclear what that agenda could possibly be? Do they blame the metformin for causing their diabetes in the first place? Maybe they do (pretty sure I’ve seen these patients before, actually) but at least Cosmo isn’t giving them a platform to state their case, because metformin and diabetes don’t inspire nearly the same fervent emotional response and conspiracy-theory-level paranoia that oral contraceptives seem to.

So while I also take issue with some of the other points you make because incorrect information and half-truths hurt my brain, this is my biggest gripe: WHAT IS YOUR POINT? Do you want us to stop prescribing medication that’s been proven to be safe and effective for millions of women because your Pill made you moody? Really?

I agree that it would be super spectacularly fabulous if we could have a brand new shiny array of options for contraception, and treatment of endometriosis, and PCOS, and all the rest. I also think that it would be pretty fab if that elusive “cure for cancer” unicorn could be discovered. But until that happens, the Pill is really, truly, seriously, a more-than-decent option to have.

In summary, if you like your Pill, keep taking it. If you don’t, don’t. (Preferably after talking about options with your trusted medical provider.) NBD either way, so let’s not make it one.

Thanks and best wishes for your pregnancy,

LB

PS: to say that the Pill “delayed” diagnosis of your endo suggests that earlier diagnosis would have changed the course of the illness for you. Not true. In fact, I would be willing to bet that at least one of your providers over the years was suspicious that you might have had endo well before you were told you did, since it’s a very common cause of severe menstrual cramps, but didn’t say the word out loud, since a) the only way to definitively diagnose it is through surgery, and b) it was kind of a nonissue, since you were on the Pill – the first line treatment of choice – and it was working!

PPS: the suggestion Ms. Northrop provides for women to simply use fertility awareness methods instead of the Pill to avoid pregnancy is irresponsible. If you happen to be someone with very regular cycles, who is also very in tune with her body, and more than likely in possession of a high level of health literacy, then FAMs are fabulous. But, first of all, 95% with perfect use isn’t quite as high as many patients who feel strongly about “no babies” would like it to be. And beyond that, let’s not forget that nearly half of all pregnancies are unplanned, and that percentage swings wildly with socioeconomic status. The Pill is most definitely not the ONLY available contraceptive method out there, but I’d much rather encourage my 18-year-old patients to get an IUD than to start checking their basal temps and cervical mucus.

PPPS: I hate to break it to you, but with your history of migraines with aura, there might a better reason than mood swings not to go back on the Pill after the babe arrives.

Fifty shades of WHATEVER

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I admit it. I read Fifty Shades of Grey.

I know what you’re thinking: didn’t you already tell us a story about consuming trash this week? Why, yes. Yes I did. Don’t change the subject.

It seemed like a good idea at the time, as most terrible ideas do. It was all buzzy and exciting and everyone was talking about it. Besides, I’d just bought a Kindle, which allowed for maximum anonymity while reading it on the subway. You don’t read your “be impressed by my exquisite literary taste” stuff on a Kindle. Does anyone ever buy the e-book version of Infinite Jest? Of course not. The only reason anyone ever buys Infinite Jest is to impress other people in college, and you can’t impress anyone if it’s hidden inside a tiny black tablet. No, smut is perfect for the Kindle.

So, I read it; I felt a little ashamed about reading it, more because of the terrible, terrible writing than the BDSM; and then I forgot about it.

Until this week. Apparently, they’re making a movie! Because of course they are. Even if I can’t help but think that the same demo that was willing to read this thing in secret might feel differently about hearing the words “One ticket for the mommy porn movie, please” come out of their mouths, but what do I know? I’m no film production executive.

But you know who is? Universal Pictures chairperson Donna Langley. Apparently, esteemed author (cough cough) E L James just loves her, because according to an article in this week’s Entertainment Weekly, she really “‘understood the material'”. Okay, so she’s an English speaker and literate. Got it. But what else? Surely there was a little something special that convinced James to sign with Universal over all the other studios beating down her door with movie deals?

Maybe it’s because Langley has things like this to say about the plight of the modern woman:

“‘Women now are forced to make so many decisions, all day, every day. The fantasy of not having to decide when, how, and where [to have sex] is just so delectable.'”

UGH, ladies, amirite? What’s with all these DECISIONS I’m being forced to make in the course of living my daily life? All this autonomy hurts my tiny, woman-sized brain. Please, go ahead and strip me of all free agency as an independent human being and reduce me to the sex object I’d much rather be. I mean it. THANKS.

But seriously: really, Donna Langley? Really? Is not getting to decide when and where to have sex a “delectable fantasy”, or is it assault? Because, um, I hate to state what should be obvious, but it really, definitely sounds like assault.

And I’m pretty sure we ladies have been fighting for the right to make other pesky “decisions” for ourselves for millennia, and many, many women throughout the world still don’t get to. So, I’ll go ahead and say that not being able to make decisions for myself would ALSO not meet my personal criteria for “delectable fantasy”, but maybe rather something more like…oh, I don’t know…oppression? Yeah, I’ll go with oppression.

Why does it matter? It’s not because I could care less whether and how you, random stranger, choose to spend your free time with a respectful consenting partner and a jumbo package of zip-ties. Because I couldn’t.

No, I care because we, as a society, have not yet earned the right to speak as cavalierly as Ms. Langley does here about about sexual autonomy.

Not as long as 20-25% of ALL college women will experience sexual assault by the time they graduate.

Not as long as the response to this completely mind-blowing statistic isn’t uniformly one of horror and outrage and petitions and marches on Washington, but instead articles like this one, in which the author – like so many before her – chooses to blame the victims for drinking, rather than blaming the RAPISTS FOR RAPING.

Not as long as your average teenage girl continues to stumble through adolescence in a haze of increasingly twisted cultural messaging around female sexuality before heading off for college, where there’s a one-in-four chance she’ll end up in my clinic one day, terrified and ashamed and alone, after a friend of a friend of a friend hands her a red Solo cup of blackout one night and proceeds to save her the trouble of deciding for herself “when, how, and where”.

Until this type of clinic visit is a distant memory, you, Donna Langley, need to stop talking.

Look, I even made that decision for you. Isn’t that just delectable? You can thank me later.

Waste not, want not

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November is a big month in the LB household. We start by waking up on the first day of the month with garishly overflowing buckets of candy from Halloween. Ugh (I say as I secretly pull my favorites when no one’s looking). Then, we have a kid birthday party that weekend. Cupcake city.

One short week later, yours truly has her own birthday. (Please, it’s okay that you forgot. You can make it up to me with a bottle of wine or three. I won’t hold it against you.) This year, my birthday brought me: 1) cupcakes at home, followed by 2) cupcakes and cookies at work, followed by 3) a delicious homemade layer cake, followed by 4) a classic Carvel ice cream cake.

It’s almost like these people know me or something. If you’ve been following my blog and/or twitter feed at all, you might have gotten a hint of the fact that I love food. I mean, I really love food. I particularly love indulgent, decadent, intensely flavored food. If the food item doesn’t actually have MSG in it, I want it to taste like it does. (Never pretended to be a nutrition expert, people.)

But even I was overwhelmed by how much dessert I suddenly had in my kitchen. And I felt obligated, somehow driven by a power larger than myself, to make sure that none of it went to waste. Not only because it was all DELICIOUS, but because the idea of throwing out perfectly good food nags at me on a deep, existential level. It pretty much never feels okay. But it feels even less okay when we’re talking about the good stuff.

I had to get strategic.

First, the cupcakes and cookies went back to work and were distributed to others willing to share the burden. The layer cake was tackled in bits and pieces – a slice after dinner here, a piece hastily crammed in my mouth in lieu of actual lunch there. But all the while, I knew that the ice cream cake would be waiting for me.

Today was the day. All the other desserts were finally gone. It was just me and the ice cream cake. I put the kids to bed, poured a glass of wine and headed to the freezer.

No ice cream cake.

I searched through that tiny, cold box at least seventy-two times (I lost count – but it may have actually been three). Eventually I sent a faux-chill text to the husband, casually inquiring as to the whereabouts of the ice cream cake. The response: “Oops. I threw it out.”

Did you know that Americans throw away 40% of our food? That’s an absolutely obscene amount of potential nutrition, going straight into the trash every day.

We health care providers feed into this epidemic of waste. Our patient advice is often fueled by our fear of the unknown. If we can’t be absolutely certain the thing you’re thinking of doing won’t harm you, we feel compelled to advise unequivocally against it. When it comes to questionable-food-related advice, this usually becomes “Just toss it. Better safe than sorry.” But at what point is this nebulous concept of “safety” outweighed by abject wastefulness?

Today I had to distribute the overpriced goods from my kid’s school fundraiser. My coworker – let’s call him Dr. Snarky – had purchased a cheesecake. This cheesecake, like all the other frozen goods from the fundraiser, had spent a couple of hours in the school gym (in mid November, mind you – not exactly swelteringly hot) waiting to be picked up before being transferred back into each family’s home freezer. Throughout it all, the box remained refreshingly cool to touch. I swear.

Making conversation, as one does, I tell him a little about the journey his cheesecake took to get to him. He looks at me and, in all seriousness, says, “You don’t think I’m actually going to eat that, do you?”

Blink. Pause. Why yes, yes I do.

As I ate a slice of Dr. Snarky’s abandoned cheesecake at my desk, I wondered: am I too lax with food safety? Am I putting my health, and the health of others, at risk by eating and/or serving food that’s past its prime?

But then I thought about the criteria I tend to use to determine which mystery foods remain edible in our kitchen. If I don’t see anything growing on it, and it passes the sniff test, we’re good to go. (I actually think the sniff test gets undervalued. Isn’t this why we developed a sense of smell, and an inborn aversion to particularly nasty smells, as a species? Ancient pre-homo sapiens who couldn’t tell that their old meatloaf had started to develop its own ecosystem of novel life forms died out; their friends, the ones with the big useful noses and refined palettes, survived.)

Back to my ice cream cake. I’m sitting there with my poor unaccompanied glass of wine when I get another text message. It turns out that the ice cream cake is still in a Tupperware container inside the trash bag, waiting on the curb for tomorrow morning’s pickup. Sealed; safe. But probably mostly melted. And INSIDE A TRASH BAG. If I really want it.

Ten minutes later, I’m eating a bowl full of melty but otherwise perfect ice cream-ish cake-ish decadence. I’m undecided at first whether this marks a high point or a low point for my life up until now.

But you know what? In the end, today was a day in which both lunch and dinner were followed by dessert. This was a good day. And if I’d decided to get all prissy about it, I’d have had neither.

So at this moment, on this night, I can say comfortably I have no regrets. And as long as I don’t wake up tomorrow in abdominal distress, I’m sticking with my answer.

NP Week, party time, excellent

Happy NP Week!!!

WOOOOOOOT! CUE THE CONFETTI! AND THE FIREWORKS! AND THE T-SHIRT CANNON! AND…and… (ahem).

I know, I know.  There’s a “week” for everything. But since I’ve been a good sport all year long, as essentially every other possible profession in the world gets their celebratory day and/or week, AND since I love having a reason to celebrate anything and everyone, I’m not planning on letting this week pass quietly by.

I’m pretty sure NP Week really just exists as an excuse for a bunch of NP-awareness marketing and outreach. And for the record, I have absolutely no problem with this. Even if it almost seems as though it should be unnecessary in this day and age, since as the AANP rightly points out, there are 171,000 of us in practice, and we’re increasingly stepping in to provide a lot of the care that needs to be provided out there in the big wide scary world that is the U.S. health care system. But despite our numbers and seeming ubiquitousness, the fact is that a lot of confusion remains about who we are and what we do. Oh right, and then there’s this. Also a problem.

And that’s why the AANP created this handy NP Week “Resource Guide”. If you want to learn more about how fantastic and fabulous the NP profession is in general (answer: pretty fantastic, quite fabulous), check them out. Or go here. Or here. Or here.

But since I’m just me, and not part of some larger organization with some larger goal with respect to NPs’ collective position in the universe, I thought I’d celebrate NP Week in my own way: by reminiscing about how exactly I ended up where I am today. And by eating free breakfast pastries, of course. You can never have too many free breakfast pastries.

When I was growing up, I had this idea that I wanted to be a doctor. And since I was one of those kids that did well in school and aced standardized tests, everyone around me assumed I’d become a doctor too. Now, I didn’t want to become a surgeon, or a radiologist, or a cardiologist. I just wanted to become the type of person I saw when I was a kid: the one you’d go see in a tidy little office for sick visits, and well visits, and ask for advice about both the little things and the big things. Who knew to ask about how your grandma was doing, and whether you’d had the chance to go skiing yet this season, and how the college application process was going.

But a funny thing happened after I shipped myself off to college and joined the bleary-eyed ranks of the pre-meds. I started volunteering at my college’s student health center, and realized all the people who were doing the things I’d pictured myself doing (see above) were actually NPs. And then, since I chose “go-getting feminist” as my undergrad activist identity of choice , I started volunteering at the local Planned Parenthood clinic. The providers there? More NPs. I started to realize that all of the people in my life who were actually DOING the things I’d wanted to do all this time weren’t physicians at all, but NPs.

So I changed course. I figured out how one actually becomes an NP, and then proceeded to do each of the things one needs to do, in the order one does them. (I won’t bore you with the details, but suffice to say that the intervening years involved many bed baths, a significant quantity of sputum, blood and poop, and a lot of humility.) But fast forward a few years, and there I was: a brand-spanking-new NP.

And you know what? I was right. I DO get to do all the things I’d envisioned myself doing as a kid. As an NP.

Obviously, the world still needs physicians. And for a whole lot of people, medical school is absolutely the right path for them.

But for me, I know that I’m exactly where I belong, doing exactly what I’m meant to be doing. And so this week, I plan on eating those complimentary pastries – I’m thinking maybe a scone, followed by a danish, but WHO KNOWS – with pride. And then I’ll slip on my white coat, the one with my name and the words “Nurse Practitioner” stitched next to the left lapel, and walk into my tidy little exam room to see my next patient.