I feel something odd and look down. My uterus and ovaries, with the familiar fimbriae, are outside my body, still attached. My cervix is bleeding a little.

I panic and yell for the X-beau. My medical brain has said "uterine inversion - you could die. Call ambulance now." I shove the uterus and ovaries back inside. They go easily.

I'm still shaking and wondering why the X-beau isn't answering, since he is still living in the house. He's the one who broke up with me, and he would help me. And my medical brain is also starting to wake up and say, but wait.....

And the uterus and ovaries are out again. No pain. I yell again and shove them back in, but I'm already thinking. It's not a uterine inversion because I have not just given birth. And the uterus and ovaries look as they look inside the abdomen, so they can't fall out that way because the anatomy is wrong. It's all attached to the vagina, so it can't do that. Older women can have a uterine prolapse, but it's the wall of the vagina that you see. Mild prolapses just into the vagina are common, but more often it's the vaginal-bladder wall (cystocele) or vaginal-rectal wall (rectocele).

By now I've stopped yelling for help because I don't need it. I've stopped panicking. I don't have a uterine inversion. This is a message. My uterus and ovaries want me to pay attention, and that's all I have to do to make them stay inside. I wake up, thinking.

So what is THIS dream about? If the dream is my unconscious trying to talk to my conscious brain, it certainly got my attention. If anyone had done a functional MRI of my brain during that one, I'll bet it was lit up like a Christmas tree, with the medical brain parts on high alert, heart rate, respiration, adrenalin and all. The female part of me coming out. And the X-Beau did not show up or answer, so no representative of the male aspects of my psyche. A very clear message that I did NOT need male help, by the time I woke up. I could handle it myself if I took in that female aspect and then paid attention to it.

I think the dream is about my own female power and female power as a physician. There is still a lot of pressure to act a certain way as a doctor, preferably like a male doctor. I have tended to make some sort of attempt to "pass" which is not whole-hearted. My notes mostly pass. But I've fought with the hospital administration over the years and tend to keep my mouth shut around my male or male-passing colleagues. In my own clinic with my patients, I don't worry about it. I've chosen to do my medical writing on Everything2 because it is not for other doctors. I can communicate with them and I'm tired of medical journal writing and physicians who don't bother to take time to explain what they think is happening to patients and even often assume that the patient can't understand it. One of my common clinic services is going over the specialist note: the cardiology note, the pulmonology note, the neurology note and explaining what the doctor thought, wrote, recommended and why. I have found people who say "I don't want to know, I just want a pill." but more often I find that people were frustrated by the specialist visit and really pleased when I explain. Even if it's bad news, even if they refuse to follow the instructions. They want to understand.

My main colleague interaction right now is with the UW Pain and Addiction Clinic via Roam Echo. Psychiatry, a pain specialist and an addiction specialist and other rural doctors who are logged on. Meanwhile, almost all of the doctors in my town are employed by the hospital in the hospital run clinics, so I'm a bit of an outcast by virtue of going solo and opening my own clinic. This is counter flow. After a year and a half the hospital still won't notify me when one of my patients is admitted. Information doesn't necessarily flow. It can be dammed. I told UW one day that I was giving chronic pain patients the site link to the guidelines for treating non-cancerous chronic pain. One said, "They can't understand that." "Of course they can," I said. "I did."

The most radical thing that I am doing is giving every patient a copy of their clinic note. I'm fast with the electronic medical record now and I hand them a copy of the note as they leave. I tell people on the first visit, "I'm going to type while we talk and you will get a copy. Then you can tell me if I missed something or got something wrong." I can't change it once I've signed it off, because that is altering the medical record and a grievous HIPAA violation, but I can add an addendum to the note. I can also add the surgery that the person forgot to the next note. It is radical to give them the note and to admit that I could get something wrong.

Now some people come back from the specialist: "He didn't give me my note," they say, outraged. I say, "Oh, I have a copy. I'll print it, we'll go over it and you can take it home." And that is what we do.

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