1. Rice, Jennifer DNP, FNP-BC

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I'm often asked about the location of my office. I smile each time the question is asked and respond that my office varies from day to day. Some days I travel scenic rural roads where I am able to breathe in the fresh country air between patients. Some days I'm frustrated while sitting in a traffic jam and unable to make the two miles to my next destination. Other days my office doesn't feel like work at all and I'm welcomed into a patient's home like a long lost family member. As a nurse practitioner who performs in-home physicals for older adults and disabled people, no day at the "office" is quite the same. I can recall a recent day that left me with an even greater appreciation for performing home-based physicals.


The day typically starts around 8 a.m. as I leave my house prepared to complete six physicals in a variety of home settings. My first patient warmly greets me on his front porch and states he remembers me from last year's exam. He immediately apologizes for how warm his home is and states that he saves on electric costs by not running his air conditioner. Temperatures for the day are projected to reach 97 degrees but by the end of the visit my patient was insistent that he would take the appropriate safety measures to stay cool and hydrated. I am humbled to visit so many who worked 40 years of hard labor and still have to make significant financial sacrifices to keep food on the table and electric costs affordable.


As I make my way to the second stop I am reminded of my love/hate relationship with the global positioning system. After driving slow enough for a moped to actually pass my car, I find my way to the correct home. The second visit was a newlywed couple in their 70s who referred to each other as "baby" throughout the visit. They recalled the story of how they met after the deaths of their spouses. It was difficult to stay on task with work because I was so intrigued by their love story! After a healthy mix of social and health-related conversation I wrapped up the visit to head to the next patient.


The fourth patient of the day was a hard-of-hearing widow who lived with her three dogs. The soft-spoken woman was often difficult to understand over the barking dogs who wanted to make sure I was not there to injure their keeper. The woman was confused regarding times she should take her prescriptions so I spent additional time providing medication education. Before I finished the visit the woman thanked me for spending so much time with her and offered to cook lunch. I politely declined but the sweet widow insisted that I take a drink and a pack of crackers before I leave. It amazes me how, on a daily basis, people who have so little think to offer a stranger so much!


The temperature is unforgiving as I pull up to the fifth visit of the day, an older single wide trailer with sheets used as window treatments. I am welcomed inside by a divorced man in his 80s who is able to recall dates with ease. About 15 minutes into the visit he lights a cigarette despite the smoking cessation discussion we just had. He extinguishes the cigarette after I asked but lights another cigarette before the visit is complete. The gentleman advises me to spare him from the lecture and states that smoking was his only vice. I respectfully listened to his opinion but couldn't leave without one gentle last reminder.


The last visit of the day was across the city and gave me the chance to take in the small town scenery and remove some of the smoky smell from my skin. My last visit was with a woman seen the previous year and she was obviously upset when I walked into her small living area. When I asked about her depressed mood the woman revealed her recent diagnosis of diabetes a few hours prior to my arrival. She was devastated about her recent visit with her primary care provider and showed me the new medication she was prescribed. The woman also showed me her new glucose meter and stated she was clueless on how to use the machine and what her blood glucose goals were. I spent our visit providing education about her new machine and encouraging her about an excellent prognosis if she makes her health a priority. The woman appeared much more at ease toward the end of the visit and was so thankful that I took the time to teach her in the home.


My office is comforting. My office is peaceful. My office is rewarding. There is never a dull day in my office because I never know who or what I may encounter at the next visit. I am thankful for the gift of a job where I can visit a millionaire one stop and someone living below poverty the next. Performing home-based physicals have provided a better practice setting than I could have ever imagined.