Nuts & Bolts of Calling a Doctor’s Office

This subject seems to come up a lot, so I thought I would do a Tutorial on how to get in touch with a person and not a machine when you’re calling a doctor’s office.

My first and probably most important piece of information is:

CALL EARLY IN THE MORNING!

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I cannot stress this enough. Even if you have to wait on hold for awhile. I tend to call about 9:45am. By then the logjam has passed and the way is pretty clear.

Calling in the morning gives the doctor the entire day to get your chart, prescribe meds or answer your questions. Lunch time is the usual time they read your message, so if you call in the afternoon, unless you are in the ER, you will be waiting until the next day for an answer.

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If you are really in a crisis (psych, serious fever or infection), I would call back right after lunch. Be your nicest self! NO yelling about “Why hasn’t she called me back yet?!?” crap. Just kindly say, “I need help. I am so ill. Can I come in tomorrow morning? Or might I talk to the nurse or doctor this afternoon?”

“I need help” is a wonderful way of garnering sympathy for your situation.

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A Practice with a Receptionist

If your doctor is in a practice with a receptionist, it’s easier to get a hold of the doc you’re needing because someone should always be available during the 9-5 workday.

You often will be triaged by a nurse before getting a message to the doctor. Still, the earlier you call, the earlier your voice will be heard.

Most offices close for lunch… either between 12pm and 1pm or between 1pm and 2pm. Calling then, you will get a machine. Leaving a message on a machine is like talking into an abyss. Call back when lunch is over.

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Calling Mental Health Professionals

Therapists especially are meticulous with the timing of their appointments. They are 50 minutes long, beginning at the top of the hour, ending at 50 minutes after. I have great luck calling in that 10 minute window between clients. Some will listen to messages and call back during that time, but many pick up the phone, too.

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Know what you are going to say. They have moments to figure out what you need before the next appointment starts. Write it down if you need to before you call. Be ready!

Psychiatrists’ schedules are a bit more wonky, so leaving a message might be necessary. Just as if you were talking to a person, have what you want to say ready. The more info you can leave in the shortest amount of time… being concise… helps everyone get their needs met.

Playing Dumb

When I really need to get through to someone (and you pick your battles here), I feign accidentally hitting the button that says “If you are a care provider and need to speak to someone now, press 1.” Use that sparingly, especially in the same practice. Really, judicious use, please.

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Bypassing Automated  Menus

If you’ve read this far, I get to teach you a trick I learned from another operator. Not specifically for doctor’s offices, but really helpful for banks, phone companies, cable companies, DMVs… any of the bazillion places that have phone trees you seem to be forever lost in.

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Press 0 (zero) fast, over and over and over again. PressPressPressPressPress a dozen or more times. 8 out of 10 times, this gets me to a person.

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Patient Portals

If you doctors’ office has a Patient Portal, sign up for it asap!

In the portal, you can email your provider, ask for refills, make appointments without calling and see your chart and most lab results.

Patient Portals are the best.

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If I didn’t answer something, ask me about it!

Fat Girl Whining

I’m fat. Really fat. Over 300 pounds fat.

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I also have Diabetes and have to see an Endocrinologist every few months. Endocrinologists take care of fat people. A lot of fat people. There has not been a time when I’ve sat in an Endo’s office that there were no less than 4 really fat people. I just left the Endo’s office (and I love the people there) and need to vent for a second.

Chairs

How can an office that caters to fat people not have chairs without arms on them? How?! The first time in there, I asked for a chair without arms and they brought out one of the bench chairs (that still had arms on it). Fine. They brought it in the exam room with me, too. Nice.

Today, the bench was there… with someone already in it. So I had to cram my fat butt into one of the tiny chairs… with the arms going INWARD instead of out! What the crap?

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I spoke with the office manager who said she’d already put a work order in for more benches and asked me to answer to survey I’ll get in my email with a comment about the chairs.

We’ll see how long that takes.

Blood Pressure Cuffs

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For fuck’s sake, I thought I had finished complaining about medical people taking my blood pressure incorrectly/painfully 2 decades ago.

  • Dealing with a stupid ER nurse using medical tape to try and keep the wrong size cuff on my arm, the tape splitting and the nurse huffing off to get his supervisor
  • Having too small cuffs bruising me dozens of times
  • Having large cuffs bruising me because I have really big upper arms with batwings

I thought I’d come up with a solution by insisting they use the cuff on my forearm. Techs and nurses balked at first, but for the last 5 years, it has been a matter-of-course to take my BP that way.

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Then today, the nurse came at me with a thigh cuff, easily twice as large as the large-sized cuff. I asked her to please take it on my lower arm and she said they had just had training saying it was required to take it on the upper arm because doing it on the forearm is “quite inaccurate.” I grudgingly said she could try, but if it hurt, I would cry.

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The cuff goes on and begins tightening. And tightening. And tightening even more. I said, “It hurts, take it off,” and it stopped pumping up so I said I’d sit still. Then it began tightening again and I nearly hollered, “GET IT OFF.” She did, charting, “Patient refuses BP.” I corrected her: I am more than glad to have my BP done, but on my forearm. She shrugged and left the room.

After my appointment with the Endo (which went really well), I asked how we were going to resolve this BP issue and she said it was “policy” and she would ask what to do. I said, “Patient requests forearm blood pressure,” please put that in my chart. She did.

Fat Anger

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We (our country) is fat… and getting fatter. What is wrong with healthcare providers that they do not make concessions for us? I’ve been writing about this since 1987!!! This is ridiculous.

Not accommodating fat people is yet another way to discriminate and intimidate fat folks. Healthcare providers not doing so prevents far too many people from obtaining care at all, care that can keep them healthier… and for you fat haters, even help fat folks lose some weight (if they want to or are able to).

Over the years, in the courts, this accommodating for “morbidly obese” people has been argued. The general consensus is now that fat falls under the American With Disabilities Act. One more thing on our side.

Please Speak Up!

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Many fat people in our society sit in these tiny chairs, put up with exam tables that do not go up and down and never ask for accomodations for their size. I speak up whenever I can, but I cannot do it alone.

Thinner/Smaller friends and family, please “see” things how we do. If you see people squished into chairs, quietly talk to the office manager, explaining how difficult the chairs are for fat people. Say you have a family member or friend (which I am!) or partner that won’t say anything, but that they get bruises every visit. If you work in an office, restaurant or anywhere people need to sit, please advocate for us to get the proper seating for fat folks.

Special mention to servers: PLEASE STOP SEATING FAT PEOPLE IN BOOTHS (unless they ask to be put in one specifically). It is humiliating to try and squish ourselves into the tight tight space at a booth.

And if anyone thinks the small chairs and small spaces are going to force us to lose weight, you are woefully incorrect. Fat-Haters, rue the day this issue is yours or someone’s you love.

Thanks for listening. Rant over.

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painter: Igor-Grabar

A Side Effect of Goodbye

I wrote my Goodbye post for my Navelgazing Midwife Facebook followers and received something that I couldn’t have predicted: love.

I Am Loved

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Thanks

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The kind words of thanks and appreciation for my writings over the last decade+ made my heart so full.

“A million times thank you. Without your influence I would never have become my own navel gazer.”

“Barb, I understand closing this door in your life and moving on but just know your words have had a great positive impact and you will be missed.”

“I have always been awed and so inspired by your ability to open up and share so boldly who you are.”

Births

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But the comments from women about their births… my heart melted with those.

“so sorry to see you go! i found you during my surrogacy pregnancy, and you were a huge factor in my choice to birth med. free.”

“While pregnant with my first son I couldn’t get enough of your blog – it is what ultimately allowed me to find my voice and speak up that I wasn’t liking the care I was receiving from my OBGYN. I chose to leave that practice and seek out a midwife. Best decision I’ve ever made.”

“I love you Barb. You patiently waited for me to find my strength to say what really caused my baby to die. You held my hand and my heart as it took me years to realize how my daughter really died. You didn’t shame or blame or deflect from the truth.” This mom went on to become an NICU nurse instead of home birth midwife after her baby died due to the negligence of a home birth midwife.

Caring for Women
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photo by Barb Herrera

And then there were the women who shared their personal paths from doula to nurse or certified nurse midwife. Stunning.

“I have followed you for so long, yours was the first blog I found and fell in love with when I realized that I NEEDED birth in my life! I’ve since gone to nursing school and become a l&d nurse, chairing our NCB Committee, and trying so hard to help women be respected and truly cared for during their experiences.”

“You have been such a wealth of knowledge for me as I completed my journey from doula to labor nurse to nurse midwife.”

“I was accepted back into nursing school today – 4 semesters stand between me and a BSN. L&D is the goal and upon graduation, my MSN to become a CNM. Thanks Barb, I owe a lot of my drive and self discovery to you.”

Thoughts

I am incredibly humbled by the comments I received on that Goodbye post. That I had an affect on so many is so amazing to me. As I write this, I am wiping tears of gratitude for all the blessings I’ve had as the Navelgazing Midwife. As is usual, the love and indebtedness people have for each other is symbiotic, flowing back and forth… a Möbius strip of love.

Thank you to all.

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My Navelgazing Midwife Goodbye

Weaning is complete.

I began my Navelgazing Midwife Facebook Page (NgM FB Page) in 2009 and will be closing the door on it Monday, March 13, 2017.

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I took this photo and used it for 10 years on my business card and in correspondence. One of my favorite clients, Silvia Frank, was killed by her husband after she left him for Domestic Violence. Her 5 daughters are amazing.

I became the Navelgazing Midwife (NgM) right around 2003 or so. The first blog I had was on Blogger, but when they snatched pages from it and censored me because I had nude women (birthing and breastfeeding!), I moved to Squarespace after making sure they would not be censoring.

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One of the favorite photographs I’ve ever taken. Jenna was nearing the end of her labor and we watched, mesmerized, as her uterus crested outside the water during contractions, then her belly sinking completely under the water after the wave. This picture was the header for my Navelgazing Midwife Blog for several years.

My first post on the Navelgazing Midwife Blog was July 3, 2004 and the last post I put there was July 31, 2016, directing folks to my new blog, the Navelgazing Writer (NgW). I’ve debated closing the NgM blog, but know there are still wondrous birth stories there and some midwifery history we would be good to remember as time passes.

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Katie birthing Uma while her mother supports and loves her. Katie’s mom has passed; looking at this, my heart soars. I took this photo.

My NgM FB Page holds much history as well, including the moment-by-moment births of my grandbabies Gabriella and Preston… and included the postpartum hemorrhage that nearly killed Meghann 36 hours after Preston’s birth. The news of my angel grandbaby Eliott is also enclosed within these pages. My newest granddaughter Alexandra’s early cesarean birth was announced there a mere 3 months ago.

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Gabriella, 5 – Preston, 2.5 – Alexandra, 1 month (my grandbabies!)

If you’re reading this on the NgM FB Page, you already know I have been weaning for a while. I left birth completely 2.5 years ago (except for my grandbabies), having left midwifery 5 years before that. News has gradually lessened; my commentary barely audible anymore.

I’ve turned to chronicling my life for my kids and their kids, sharing my knowledge of and inclusion in the early LGBT communities in Orlando, Florida, Frankfurt, Germany & San Diego, California. I have barely begun to share the story of my 2+ decade-long relationship with Zack (previously known as Sarah) and the impact of his transitioning on our lives.

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Zack (before his transition) nursing his son and my daughter Aimee. We co-nursed for 2.5 years, often saying all families should have 4 lactating breasts in the home. I took this picture, circa 1986.

Interspersed will have to be birthy stories… I just wrote 2 about the immigrant populations I worked with in San Diego and El Paso, Texas. Birth has been an integral part of my life since January 1983… I could not write my autobiography without including it. I just have a different viewpoint now that I am above and far away from the stories that once affected every aspect of my spirit, emotions, relationships and friendships.

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Shayla and her then-husband. Shayla had one of the most horrific hospital births I attended in 32 years. Exhibit A demonstrating blatant racism in maternity care.

I’ve had a sort of hidden life for a long time… one of intense sexuality and BDSM. I was a lifestyle submissive with my former partner Zack and am writing about these things as well.

My life since puberty has been colored with mental illness. Bipolar Disorder and Depression and are well-represented in the NgW blog. Much more to come as the blog is still fairly new.

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I was addicted to opiates for 8 years, it sliding through my sister’s dying of an accidental overdose on opiates, Fentanyl being the actual cause of her death. I am now 2.5 years clean and share that story in my new blog as well.

My body, at almost 56-years old, is tired, disabled and in a lot of pain; Mindfulness Meditation and 800 mg. ibuprofen are my pain relief. I struggle with a plethora of issues, most fat-related. It is crucial for me to write about my life as a fat woman, someone who’s tried a hundred times to not be fat anymore, but still fat after trying it all. My feet have arthritis and keep breaking just from walking. I have osteoporosis (from the gastric bypass). My diabetes, while okay at the moment with a HgbA1c of 5.9, that is with 2 insulins on board.

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Since leaving birth, I’ve become a sex worker. I’m not writing a lot about it at the moment, but it colors my life tremendously. Amazingly, all the years of birth work and therapy have armed me adequately for caring for the men, women and transfolks I work with every single day. There is not one day when my birth experiences do not figure prominently in the interactions with others.

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Because of the state of the United States right now, I explored different topics about which to write, but quickly saw that, not only did some topics affect my mental state, but a zillion different ones joined the list every day. I needed to focus my attention and have chosen Freedom of Speech and Freedom of the Press as my main demonstration issues against 45.

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Illustrator, Eric Drooker

It’s been an interesting shift in my thought process, from birth to politics. I’m observing my Self intently, monitoring my emotions, mental state, my body’s physical responses and lastly, what those around me have to say about what I’ve written. The NgW Blog is still really small, very few readers with each post, but it took about 2 years for the NgM Blog to pick up steam, so I’m not sweating it. Also, I really am writing for myself, giving flight to my thoughts and experiences, and if others find what I write helpful or creates a visceral response, all the better.

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There were only a couple of posts in the NgM Blog that were written with the reader in mind and whenever I did that, I regretted it. Of all the posts, only one was removed and edited because of the backlash I got from my licensing organization. (I cannot tell you how freeing it is to be completely unrestrained now, writing writing writing without someone threatening my livelihood. There really are nasty, ugly parts to midwifery politics in the US.)

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I know many of you reading have followed me for a long time. I cannot thank you enough for considering my views and listening to my thoughts, even when you disagreed with me. Thank you for challenging me, making me think… allowing me to shift and change and grow. I am not the same woman who created the nom de plume “Navelgazing Midwife,” but you are not the same either. Isn’t it amazing to witness our own growth and transformations?

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Endless gratitude to all of you and may your lives and the lives of those around you be filled with boundless love and light. You will never be forgotten.

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Who Is “45”?

“45” is what I call POTUS, the 45th president of the United States, that horrid man who squats in the White House tweeting (LYING) about random topics to divert our attention from the fucked up bullshit he does that will, PLEASE GODDESS, get him impeached.

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Politics: Brokenhearted

I go a couple three days without reading even headlines. Then, like tonight, I peek at what is trending.

And now I am despondent.

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artist, Anna Giladi

Just the headlines are enough to make me want to crawl in a hole. Imagining these people in control, making rules and regulations (or undoing regulations as the case may be)… it’s terrifying.

Rape

I do not say the word “rape” lightly. I do not use it randomly. I have been raped. I know the seriousness of the word.

So when I say I am horrified seeing who is going into the Cabinet because they are going to rape the United States, I mean it with all the terror that comes with the word.

The people being appointed are going to make the Dakota Access Pipeline (DAPL) “conflict” look like a picnic. They are going to dig deep into the land, tearing up beautiful homes, ruining National Parks… and the repercussions will be felt/known/experienced for hundreds of years after these fucking pigs are out of office and dead.

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Hopeless

I felt hopeless for a couple of hours. My chest felt like someone was sitting on it; I struggled to breathe. My blessed cub held me and talked to me as I cried about how horrible this all is.

And it hasn’t even begun yet!

I think that’s the scariest for me is if I am this upset and sad now, what am I going to be like in a year when we are in the middle of the rape, still years ahead to be attacked… every which way we try to get away, to fight our attacker, he strong-arms us and continues the assault.

Not Giving Up

I saw this photo:

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I cannot let anyone die alone.

No LGBTQIA+ youth who is outed because of new laws will not be alone. We will do everything in our power to save you from the evils of “conversion therapy”… torture.

No woman who has to have an illegal abortion because abortion has been outlawed will not be alone. Those who can will learn to do abortions safely, despite the laws, risking jail, but finding the risk is far less than a woman attempting self-abortion.

No Muslim who has to “Register” to be in this country will not register alone. Women who have their hijabs mocked or pulled off will be defended so she is able to practice her religion in this country that still allows religious freedom (so far).

No woman who is attacked… grabbed “by the pussy”… will not mourn and heal alone.

No Black man, woman or child will endure the escalating hate and murder alone.

No immigrant, here legally or “illegally,” will fight to live here alone.

No Native American will have to wrest their rightful land back from the lying White people alone.

No disabled person will be left to live or suffer alone. We will find the tools they (WE!) need for anyone who still has needs. We will not let the world become completely able-ist, forgetting/not caring for those who have challenges.

No writer, photographer or artist will be censored. We will find ways to get the words and images out to the world.

No child who is hungry and has lost their free breakfasts, lunches or dinners will starve alone. We will find food for you precious babies of ours.

And then there are the promises I cannot keep:

We will not know the impact slashing Social Security will have on our elder Americans. Will they die alone freezing and starving while those in charge have billions of dollars to spare?

What are we going to do for our mentally ill (myself included)? What if our free care is removed? What if we are not allowed our medications, therapy, our psychiatrists?

We know a only fraction of our brothers, sisters and others who have killed themselves because of their despair of who is coming into the White House. What of all the others who are misgendered, hidden, reported as dying of “natural” or “accidental” causes when they really overdosed on purpose. So many suffering without our knowing they are there.

I need to go house by house looking for those in pain. Like the Christians in Germany who saved the Jews, taking chances, risking death even… all to save even one soul.

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Reaching Out

I might cry again. No, I will cry again.

But I cannot give up. I cannot let someone die reaching out for another hand. I know mine is not the only one searching. Maybe, just maybe, if we all keep holding our arms out, joining hands, we might be able to save more than just one person.

I cannot give up.

Fat Girl Stories: The Fucking Pap

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Warning: Lots of fucks to come.

NOTE: I am a retired midwife. That alone makes many, many people nod and say, “I can see what’s coming now,” because care providers are the worst patients ever. I lived up to that expectation. In spades.

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I had to have my Pap yesterday morning. It took until this morning for me to be able to relive the experience for a post.

It Unfolds This Way

I am ushered behind The Door by the Nurse-Practitioner’s assistant (LPN? I don’t know) and right there is the fucking scale. Knowing my weight, I told the girl and she said I had to get on the scale, she cannot take my word for it. I looked at her and said, “I am not getting on the scale.” She says, pretty snotty-like, “Patient refuses weight” and jots it on my chart.

I rolled my eyes.

She takes me into the exam room and there, laying out is the baby-sized paper top and a teeny sheet to cover yourself with. I wore a shift with no undies, no bra, expecting to just lift everything up. Easy peasy. I also spied the plastic speculum in the wrapping: medium.

The assistant took my blood pressure (incorrectly) on my forearm and I had to show her where to put the bladder tubing over my artery on my lower arm. She wasn’t happy I changed her rhythm. Tough shit.

Went over meds, any current problems, past STDs (HSV & HPV) how many sexual partners this year. I laughed. How many in a lifetime? I said hundreds. She turned and said, “Are you serious?” (which I thought was rude as fuck); I said I was. I imagine she then typed into the computer: DO HIV TEST.

When she was done with the computer question & answer part of the fun, she proceeded to tell me to take off my bra and underwear and put the teeny covering over my top, opening in the front for breast exam and to cover myself with the miniscule paper drape. Even the Chux on the table was infant-sized. Then she left.

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Decisions Decisions

The table was lower than the one above, so I sat on it… on the Chux and drape, with zero intention of taking my stretchy dress off.

Then my mind started going:

She (the wonderful Nurse-Practitioner) isn’t going to be able to see your cervix with that medium spec. You need a large at least, if not x-tra large. I already know my walls fall inward ( a common multip and/or fat issue, of which I have both). What if I need the specialized ones where the spec has the blades on the side, too? What if I need to go see a GYN? Are they going to fat-shame me because I need a special speculum? I hate Hate HATE putting my legs in the stirrups. (I can feel the tears welling in my eyes just writing this out.) What if she tries with the medium and cannot see my cervix? Then I will have to see someone else and do this all over again. Maybe I will just skip it altogether and just talk about my Dexa Scan and the Hematologist I need to see for my chronic anemia.

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Where did all this anxiety come from?! Fuck, I have had at least 30 or 40 pelvic exams before, including student midwives so they could learn what a fat body feels like. This was so different, though.

Maybe I will just skip it altogether.

The Visit Begins

In came the NP and the assistant who was already gloved (a no-no). I didn’t say anything because I was too anxious about my body.

I love this NP. We share an obsession with Disney stuff and talk about it all the time when I see her. I told her how good it was to see her and I relaxed a little.

She had the HIV test in her hand (we used to do the oral ones when I was a midwife, too) and I said, “I guess you want to do the HIV test now?” and opened my mouth. She did the swabby thing over my cheeks and gums and then put it in the solution for the 20-min wait.

I shared my latest labs. My HgbA1c was down from 7.7 to 7.2 in 3 months. Yay! She was going to give me a referral to the Hematologist because my anemia had now turned chronic (Hgb of 9.9-10.1 over 9 months) and to the Endo again for the osteoporosis I now have (both the anemia and the osteoporosis from the Gastric Bypass in 2001) to get shots.

I then point to the speculum on the side table and tell her it ain’t gonna fit, do they have a large one? Ayup. They do. The assistant chick got it out from under the cupboard.

I say I do not want a bimanual exam because she won’t feel anything anyway and they always hurt because the provider tries so hard to find my tubes and ovaries and my liver already hurts. She said no problem. Just the Pap. (The fucking Pap.)

She asked if I had had my mammogram this year. Nope. Do you want a breast exam? Nope. Just the mammogram; I examine my own breasts, thanks. She said, “No problem.

The Fucking Pap

Then it was time when I had to lay back and put my feet in the stirrups. I whined about how fucking flimsy they were and she said she thought they were better than the leg supports and I said that, for fat people, the leg supports are far superior because it is difficult to keep our legs under control in the lithotomy position.

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Add about 200 pounds on her.

She put her gloves on then began touching my labia and I felt the fucking speculum. I know they aren’t supposed to hurt and for fuck’s sake I have done 100s of spec exams on women myself so know how it goes for many… it isn’t comfortable. Or pleasant. For me, they fucking hurt.

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Ow ow ow ow ow ow ow until she was in and swerved the spec around upright, then the pain stopped. Opening it was fine. She said, “I see your cervix right there!” I was so happy I could have screamed. When she took the specimen, it didn’t hurt. Coming out was fine. That going in… sheesh. Sex sure doesn’t hurt like that. (Lube, lube and more lube, that is why. No lube is used on the specs lest they contaminate the specimen.)

And she was done. I wanted to cry with relief because she found my cervix so easily, didn’t have to take it out and retry again and again or send me to someone else. Goddess forbid something be wrong and I need to have dozens of them. Ugh.

(And in case you are wondering, yes I am a Survivor of Sexual Abuse & Rape and am sure that has an enormous hand in my discomfort issues.)

And my HIV test was negative. Yay! Good for 6 more months.

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C=Control= Negative

Fuck am I glad that fucking thing is over with for a year.