Karen stared at the blank document. The cursor blinked. She had been staring for eleven minutes.

"Patient Requested Procedures Guide," she typed. Then deleted it. Too clinical.

"Understanding Your Treatment Options." Delete. Too condescending.

"What Happens Next." Delete. Too vague.

Her phone buzzed.

STEPHANIE: how's the form coming

KAREN: it's not

STEPHANIE: legal breathing down your neck?

KAREN: legal wants "comprehensive documentation of patient understanding"

STEPHANIE: aka cover their asses

KAREN: while actually helping people understand what they're agreeing to

STEPHANIE: impossible

KAREN: yes

Lauren joined the text thread at 2:17 PM.

LAUREN: cartwright says we need draft by tomorrow

KAREN: I know

LAUREN: current version?

KAREN: "Dear Patient, You're about to request things that will help you shit. Sign here."

LAUREN: needs work

STEPHANIE: slightly

They met in Conference Room B at 3:00. The fluorescent lights made everyone look sick, which seemed appropriate.

"The problem," Karen said, "is the language. Medical terms scare them. Plain language sounds crude."

"Mr. Henley fled when I said 'digital stimulation,'" Lauren offered. "Thought it involved computers."

"Mrs. Patterson cried when I explained suppositories," Stephanie added. "She thought they were pills. No one told her where they went."

Karen pulled up her latest attempt on the screen:

"This guide explains procedures you may request as part of your treatment. Each procedure is designed to help restore normal bowel function. You are never required to request any procedure. You may stop any procedure at any time."

"Boring but clear," Lauren said.

"Clear is good," Stephanie said. "Clear is revolutionary in medical writing."

They worked through each procedure. How to explain without terrifying. How to be honest without being brutal.

"Suppository administration," Karen read. "A small, medicine-containing insert placed rectally to stimulate bowel movement."

"Accurate," Lauren said.

"Terrifying," Stephanie said.

"Both," Karen said.

They tried again.

"A suppository is medicine in solid form that dissolves in your body. It works directly where needed, often more gently than pills."

"Better," Lauren said.

"Still scary," Stephanie said.

"Everything we do is scary," Karen said. "That's why they're here."

This was true. Their patients had scared themselves into dysfunction. Now they needed to request the very things that scared them. It was perverse. It was necessary.

An email arrived from Dr. Cartwright at 4:45.

"Team, Remember: the goal is not to minimize what we do but to normalize it. Patients who understand their treatment participate more fully. -HC"

"Normalize," Stephanie repeated. "How do you normalize someone requesting that we help them defecate?"

"By making it medical," Lauren said.

"It is medical," Karen said.

"Is it though?" Stephanie asked.

They sat with this. Was teaching adults to request help with their most basic function medical? Or was it something else? Something stranger?

Karen tried another approach:

"Many patients find it helpful to actively request procedures rather than passively receive them. This puts you in control of your treatment."

"Control," Lauren laughed. "They're asking us to insert things into them. That's the opposite of control."

"It's the illusion of control," Stephanie said.

"The illusion is important," Karen said.

This was also true. The forms, the requests, the signatures—all of it was about creating a framework where humiliation became therapeutic. Where asking for help became empowering.

By 6:00 they had a draft. It was twelve pages. Too long. They cut it to eight. Still too long. They cut it to five.

"Essential information only," Karen said.

"It's all essential," Lauren said.

"Then we're fucked," Stephanie said.

They were a little fucked. How do you explain in five pages what might happen over months of treatment? How do you prepare someone to request things they can't imagine needing?

Final version, page one:

"This guide helps you understand procedures you may request during treatment. Requesting treatment is an important part of healing. You know your body best. We provide the medical expertise. Together, we develop your treatment plan."

"Together," Stephanie read. "Like we're partners."

"Aren't we?" Karen asked.

"I insert suppositories into grown adults," Stephanie said. "That's not partnership. That's something else."

"What would you call it?" Lauren asked.

Stephanie thought. "Necessary weirdness."

This was the most accurate description yet. But you couldn't put that in a patient guide.

They added a section on each common procedure. Simple language. No judgment. Facts.

"Some patients worry about requesting these procedures," Karen wrote. "This is normal. Your care team has performed these procedures many times. What feels unusual to you is routine to us."

"Routine," Lauren said. "Digital extraction is routine."

"It is for us," Karen said.

"That's the weird part," Stephanie said.

At 8:00 PM they had a final draft. It wasn't perfect. It couldn't be perfect. How could any document bridge the gap between needing help and asking for it?

Karen emailed it to Dr. Cartwright. Subject line: "Patient Requested Procedures Guide - Draft."

She didn't mention their concerns. Didn't mention that no form could make the strange normal, the humiliating therapeutic. The form existed. That was enough.

Her phone buzzed at 8:47.

DR. CARTWRIGHT: Received. One note: add a line about how requesting procedures often becomes easier with time.

Karen added it. "Many patients find that requesting procedures becomes more comfortable with practice. What seems impossible today may feel routine in a week."

This was a lie and a truth. It did get easier. But it never became easy. The gap between needing help and asking for it never fully closed.

She saved the document. Version 1.0. By next month it would be version 5.0. By next year, version 20.0. Each version trying to capture something uncapturable: how to make adults comfortable asking for help with their most basic functions.

Stephanie texted at 9:15.

STEPHANIE: drinks?

KAREN: yes

LAUREN: yes

They met at Murphy's. The same booth. The same wine. The same attempt to wash away the day's necessary weirdness.

"To patient-requested procedures," Lauren raised her glass.

"To necessary weirdness," Stephanie corrected.

"To version 1.0," Karen said.

They drank. Tomorrow there would be patients to guide through the forms. To help understand what they were requesting. To watch as they signed their names to procedures they never imagined needing.

But tonight there was wine and the shared understanding that some things couldn't be captured in forms. That the real document was unwritten: the gradual acceptance that bodies fail, that help is needed, that asking for help is its own kind of strength.

The form was just paper. The real work happened in the space between needing and asking, between shame and acceptance.

They knew this. Their patients would learn it.

One signature at a time.