All I knew before going in to see my fourth patient of the day was that she "desires change in birth control," and that she has been receiving Depo-Provera shots since she gave birth in 2003. The following dialogue (or one close to it) ensued:
Me: Good morning, my name is Emily, I am the student working in the clinic today.
Patient: I seen you before. (She had, in fact, six weeks ago at a pediatrician's office whre she had taken her older child for a kindergarten physical. At that time she informed me that she didn't like students, and that she didn't really care for her children, either).
Me: Oh, yes, hello. So, you want to switch from the Depo shot to another form of birth control, right?
Patient: Hell yes.
Me: What is it about the Depo shot that makes you want to switch?
Patient: I be bleedin' all the damn time, girl, and I can't get no ass when I be bleedin'. I ain't gonna got his whole winter without no ass.
Me: So you are bleeding in between periods?
Patient: Damn straight.
(We continue the conversation to get more info about the nature of the bleeding)
Me: Have you been having any weight gain or mood changes since you've been on Depo?
Patient: No weight gain. I maybe been in a bad mood, though, but probably because I can't get no head and no ass and that make me crabby.
Me: What kind of birth control do you think you would like to switch to?
Patient: Whatever don't make me bleed, but I ain't puttin' nothin' in my coochie.
Me: So you wouldn't be interested in the Nuva Ring? You just insert it in the vagine once a month and leave it there, then you don't have to take a pill every day, and you only have to think about it every four weeks.
Patient: Hell no, ain't nothin' goin' in my coochie. You know how it be when a man got a big ol' dick and you don't know how it be rockin' around in there movin' shit around.
Me: Do you want to try oral birth control pills?
Patient: Yeah, I'll do those. I been on 'em before, but this time I'll remember to take them everyday because before I forgot and that's how I ended up with him (pointing to her 13 month old running around the room).
Me: So you know how important it is to take it every day at the same time?
Patient: Every morning when he wakes me up at 7:30 the first thing I'm gonna do is take that pill. Also, can you look down there and check everything out and make sure I don't got no infections or diseases? It been a few months since a doctor checked me.
(We wrap things up and I go to wait for my attending to come in so we cn complete the physical exam and counseling. Before we go in, I let the doctor know about the patient's concern over her lack of ability to get any ass or head)
Doctor: So, Emily has been talking to you about some birth control and I hear you aren't happy with the Depo and want to try the Pill again?
Patient: Doctor, like I told her, I be bleedin' all the time and can't any. I got a birthday comin' up and the holidays and you know how we be, I don't wanna go without.
(Most of the conversation I just had with the patient is then repeated with the doctor. I am then instructed by the doctor to do the genital exam, which I am really looking forward to connsidering the lovely things I may be about to find.)
Me: Have you had any increase in discharge? (There is a plentiful amount.)
Patient: There been a little more discharge. I think it stinks, too.
(As I am in the prime location, I can verify the odor)
Me: How long have you had the increased discharge and odor?
Patient: I don't know. I just think it smell like a dead racoon.
(I have heard those "female odors" compared to many things, but this is the first time road kill has been used as a descriptor. I do the pap smear and then take specimens I need for the STD testing. That concludes the physical exam.)
Once the doctor and I finish the exam, write the prescription for a drug to treat the bacterial vaginosis (source of dead racoon smell), and give her a sample of Seasonale (the Pill you take for three months in a row without any placebo weeks so you only have you period once every three months), and a prescription to have the birth control refilled (please please please let her get this prescription refilled and use it, daily, for a very long time), we send our lovely patient on her way, off to merrily begin her pursuit of ass.