=== Chapter 8 Last Day: Part 2 Exams ====

It was an hour or so later when Dr. Lee came in, followed by two medical students, William and a blond woman named Kate Mcgrue who had just recently started this rotation. She was pushing a cart filled with tools and supplies.

Looking at them in turn, Dr. Lee said, "Jenny, Kelly, Bill. I'm sorry that I could not make it up earlier, but today has been chaotic. We couldn't use our intake area because a patient showed up in it with an active case of measles and we are still trying to get caught up."

"Jenny. I have reviewed your x-rays and I am discharging you this afternoon. We have let your family know and your mother and Lisa will be picking you up around 5 or so. I'll leave written discharge instructions, but you will still need to rest for a few days. If you don't relasp, you can go back to your regular activities, school or work, Monday. Just ease yourself back into things."

"Bill, I'll do your intake exam as soon as I am finished with Kelly."

Dr. Lee then walked over to Kelly's bed. She gave the curtains a slight tug, but mostly left them open. "Well Kelly, I hear that you are not feeling well and based on your x-rays, I am not surprised. I am Dr. Samatha Lee. I will be in charge of your care. These two, William and Kate, are medical students who will be helping me. Kate, can you present Miss Smith's case?"

Kate took a second to gather her thoughts and glanced a some notes she had made to herself from reading Kelly's chart. "Kelly Lynn Smith is an 18 year old white female who was referred to the ER from her pediatrician for possible pneumonia. At the ER she presented with coughing, difficulty breathing, lung congestion, and a fever of ... 103.8 measured rectally. Chest x-rays show both lungs inflamed ? Blood and sputum cultures have been started."

"Not bad for a first time, but be a little more confident in your facts. Now what would you recommend as a course of treatment?"

Kate looked a little panicked. "Umm, O2, I am not sure how much. A course of steroids and antibiotics based on the cultures."

"William will show you how to calculate the needed O2 flow and the medication doses. We won't wait for cultures to start the antibiotics though. I'll pick something broad spectrum to start after examining her and adjust if needed when the cultures come back."

"Well, Kelly, can you tell me how this came on? Have you been sick for a while or did it come on all of a sudden?"

Kelly described feeling more and more sick and tired over the course of a week and suddenly feeling much worse last night. She made sure to mention that she was bad enough this morning that her mother tried to get her in to Kelly's GP, her real doctor, only going back to her old pediatrician because he had no appointments.

Dr. Lee listened closely, asking her a couple of questions and then said. "OK, let's have a look at you. Kate, I will have you repeat parts of the exam. We know she has pneumonia, we are trying to determine how bad it is and if there are any secondary infections."

She started with an otoscope, doing a standard ears, nose and throat exam. "Look in her ears Kate. You will notice that the right ear is slightly inflamed."

After Kate looked in Kelly's ear, Dr. Lee put on her stethoscope and said “Let's listen to your heart and lungs." And with no more warning, untied the top 3 ties on Kelly's gown and pulled it down to her waist, causing Kelly to give a little eep. This was the second time she had been naked (well topless) in public today and with Tim right across from her. At least he seemed to be politely pretending to read.

Dr. Lee places her right hand on Kelly's chest and used the left hand to place the bell of her stethoscope on the girl's back. "Please breath in and hold your breath. Now let it out." She repeated this until the teen had a coughing fit.

"mmm... OK Kate, it is your turn. Put the bell here and put your other hand on her chest. Don't be shy, put it right over her breasts. Sometime you learn from how the patient's breathing feels. Now have her breath in and out and remember how that sounds. The wetness of it. You can contrast to how Bill's lungs will sound."

Next Dr. Lee felt the girl's throat, asking her to swallow. Kelly twitched a bit as Dr. Lee's went to her armpits and the sides of her breasts. Kelly was sure that she was going to die of embarrassment. "Please don't have the male student do the exam." she offered up as a silent prayer. For once this day, her prayer is answered.

"Kate. Repeat the exam and tell me what you feel."

Kelly felt Kate's cold hands on her throat. She seemed to linger a little longer than Dr. Lee did before asking Kelly to "Please raise your arms for me."

Kelly did and felt Kate's hands dig into her armpits for me. She seemed to linger there before Dr. Lee prompted, "A little more medial too."

Kelly then felt Kate move her hands to the outside of her breasts. She pressed along the outer edge of each breast, starting at the top and working her way down.

After she finished she quickly removed her hands and told Kelly that she could lower her arms and pull up her gown.

Turning to Dr. Lee, she said, "The nodes in her throat are slightly enlarged and the axillary lymph nodes are more so."

"Correct. And what should we do to complete the exam? And what would we expect to find?" Dr. Lee asked her.

Kate hesitated. "We ... I should check the inguinal lymph nodes? They should be normal or near normal?"

"Correct, but don't make it a question. Now perform the exam. I will double check when I finish my exam." Dr. Lee said as she pulled the curtain a little more, but not completely, closed.

"Can you lie back down Kelly?" Kate said as she gathered her nerve.

After Kelly lays down Kate folds her gown out of the way to expose the girl from the belly button down, reveling thick patch of blond hair between the girl's legs. Kate spread Kelly's legs a bit and puts on Kelly's thigh near her labia, but avoiding them uncomfortably. She spends some time finding her landmarks before carefully feeling for the lymph nodes. After a couple of minutes, she repeats this on the other side.

"They are normal in size and shape and are mobile."

Dr. Lee nods and takes out her stethoscope. "I have just a few more things to check and we'll be done. Thanks for being a good sport, Kelly." Dr. Lee says as she starts to listen to Kelly's abdomen.

"Like I had a choice?" Kelly thinks. Still, at least the male student is only watching.

Dr. Lee systematically feels each section of Kelly's abdomen, pressing gently as she goes back and forth while watching Kelly's face for signs of pain. She makes a second pass, pressing more firmly.

"Just got to check you out down here Kelly. Just going to feel on the outside and look between you labia and at your bottom." Dr. Lee says as she is putting on gloves.

Dr. Lee gently pulls Kelly's legs apart and quickly palpates her groin. She quickly feels Kelly's outer labia and then parts them. She takes a quick look without inserting a finger.

"Turn over please." Dr. Lee says. She helps the girl roll over and parts her buttocks with both hands. After a quick glance at her anus, she releases the teen's buttocks and pulls off her gloves.

Picking up the girl's chart, she says, "You can turn over and cover up Kelly. You have a moderate to moderately sever case of double pneumonia. Both lungs are inflamed but it hasn't spread to a general sepsis. Still, we need to get this under control before it gets worse. I am going to start you on a daily course of IM penicillin G and steroids until we get the cultures back. Based on that, I might change the antibiotic, but I think penicillin G will probably be the right choice and a course of 7 to 10 days of it should knock out the infection."

"I'm sorry that the injections won't be the most fun, but I think it is the best treatment for you. I'm going to keep you on the oxygen, but you can be off it for brief periods of time, like to go to the bathroom, just ask the nurse to help."

"I'm not going to start you on IV fluids yet. Yet. If you get dehydrated or we switch you to an IV antibiotic, we will, but not now. So drink lots of water."

"Your condition is serious, but we have caught it in time. Any questions?"

"No. Not now." Kelly was a little stunned. So many fingers in places. So many shots.

"Well, I will be back to check on you tomorrow if you think of any. William, write up the medication orders: 1,000,000 units of penicillin G IM daily, pick a steroid, Tylenol PR, an expecterant, and the probiotic mix. IV fluids if needed for dehydration. I'll review them and sign them. Kate, let's go over and examine Bill. You will be doing a genital and rectal exam on him. Bring the cart."

With that, she pulled the curtains fully open and headed over to the next bed. Kelly was left in bed wondering what had all happened. And how many shots?

The curtains around Kelly's bed hand been mostly shut. However, Bill had been listening to what was going on and caught glimpses through gaps. From what he heard, he was pretty sure that an exam from Dr. Lee was likely to be like an exam from Dr. Taylor, through. When Dr. Lee pulled the curtain around his bed, he was pretty sure that he would end up naked in front of the two women.

"Good afternoon Bill, I'm Dr. Samantha Lee and this is my student Kate. I will be helping Dr. Stein with your care. He will be handing your surgical care and I will be available for any medical care that is needed outside of your surgery. I will be examining you to make sure that you are fit for surgery."

"Why doesn't Dr. Stien do that? Why bring more doctors in?" Bill asked, genuinely curious.

Samantha smiled, "Oh surgeons don't like to get involved in messy medical stuff. They don't like to stray to far from their area of specialty. Might dirty their delicate hands."

"Seriously, I am mostly here to make sure there are no medical surprises for Dr. Stein to run into when you are on the operating table. It doesn't happen often, but every once in a while I find an issue that may delay surgery or make them adjust something. Just last month, I discovered a heart condition that you would not like to discover on the operating table."

"But, so far, you look fine. I don't suspect that you will see much of me during your stay once we finish your pre-op exam."

"Now, I apologize to be doing the exam here. I would usually preform this exam in the intake ward or take you to one of the treatment rooms for more privacy, but today has been chaos and none are available."

"Let's get started. Can you sit with your legs over the side of the bed?"

As she reached in the cart for an otoscope, Dr. Lee said "Kate, please untie the ties on his gown for me." It would speed up the exam and she needed to break Kate of her squeamishness around nudity.

Kate stepped behind Bill and untied the ties on his gown. She hesitated only slightly at the bottom tie near his butt.

Dr. Lee was already turning Bill's head, looking in one ear and then the other. "Normal" she muttered and then shone the light in each eye checking for the reaction of the pupils. Tilting his head back she looks in each nostril.

Finally she grabs a tongue depressor and tells him to open wide and say "Ahh". She gets closer and Bill can feel her breasts against his chest as she looks down his throat for an uncomfortably long time.

Finally stepping back, she says. "That was a remarkable catch by your regular doctor. You have to be at just the right angle to see it. It is almost hidden by your tonsils and I could see how it would provide a place for infections to fester."

"Yeah... I mean yes. I've always had a lot of sore throats. At the last one, Dr. Taylor stared down my throat for five minutes from half a dozen angles before grinning and saying ah ha."

"Well let's check out the rest of you." Dr. Lee said as she pulled Bill's gown off, leaving him naked to the waist.

She then went and felt his throat, asking him to swallow. She then proceeded to palpate each armpit and the side of his chest as she had with Kelly.

Turning to Kate she said, "Feel the throat and axillary lymph nodes and compare that in your mind to the last patient. You can check the inguinal nodes when we do the genital exam.

Bill gulped a bit as Kate and Dr. Lee changed places. He had figure on the possibility of something down below based on what he heard from Kelly's exam, but he had still hoped to be spared a genital exam.

Dr. Taylor gave ... very complete exams, so he was used to genital exams from female doctors, but the student too? And the three girls in the room. They couldn't see much, but they could hear everything.

"They are much smaller and more mobile. Thank you for letting me examine you Bill, this is very helpful." Kate said before letting Dr. Lee take back control of the exam.

Dr. Lee did a quick reflex check and had Bill "smile big" and then checked his strength in his hands and arms.

She then took out her stethoscope and listened to Bill's heart. She started with the bell under his left breast, listening closely for any sign of a murmur.

Leaving her right hand on his chest, he moved the bell around his back asking him to breath deeply.

She then thumped him on his back over his kidneys, asking, "Does that hurt?"

Making some notes in his chart she says, "Just a few more things. Lie down on your back."

Bill does as she asks, careful to keep his lap covered with the gown. But as soon as he is lying down, Dr. Lee pulls the gown down to mid thigh, leaving just enough to hold his penis out of the way.

Looking at Kate as she puts her stethescope back in her ears, Dr. Lee says, "When doing the abdominal exam, be sure to expose the patient from just below the breasts to just below the pubis mons. Don't let prudishness keep you from doing a proper exam."

With that she used her stethoscope to listen to his abdomen. She followed up with a thorough palpation. She started at the top and gently pressed into his abdomen going back and forth until she was pressing just above his penis, which had started to grow a little.

Bill had turned a little pink at this point, but years of anual exams by Dr. Taylor had gotten him used female hands probing him down there. Although Dr. Taylor was older and more ... maternal than Dr. Lee or Kate.

Then Samantha removed the gown altogether, leaving Bill completely naked. Dr. Lee took each leg in turn, moving it through a range of motion before setting it down.

"I just need to do a genital-urianry exam and a rectal and we'll be done. Please stand up with your back to the curtain right here." Dr. Lee said as she squirted some surgilube on a couple of pieces of gauze and put on some gloves, handing a second pair to Kate.

Bill stood up with his butt up against the curtain. He was uncomfortably aware that Kelly was just on the other side of the thin curtain. She couldn't see through it but it was clinging to his backside. And then there were the two women (one not more than a few years older than him) that were about to handle all they were seeing. He tried to think of baseball as he felt the warmth from the portable lamp that was pointed at his penis.

Not having a stool, Dr. Lee sat on the edge of the bed to get down to pelvis level. She took a few seconds to look at Bill's genitals, looking for any sores, or other visible issues. Speaking mostly to Kate, she said "The patient has a normal sized, circumcised penis with a normal hair distribution. There are no visible sores, nits, or other issues." She had learned not to upset the male patients by using the more correct term unremarkable.

"You are going feel me touch you now." Dr. Lee said as she gently palpated his penis. She started at the base squeezing gently from the top to bottom as she moved towards the head, stopping just short. She then went back to the base and repeated the palpation this time squeezing on the sides.

Finally, she took the now partially erect penis in hand and tilted it up, squeezing the tip genital to look in the meatus.

As she took one testicle in hand, she asked Bill, "Have you been taught to do self exams? Do you examine your testicles monthly?"

Glad for the distraction, Bill said "Yes, ma'ma. Dr. Taylor made sure that I did them right." Made me do one in front of her, he thought.

"Good for her. Now turn your head and cough." Bill did and then she moved her finger to the other side, inserted it. "Cough again"

She pulled out her finger and quickly felt his lymph nodes and femoral pulse.

"OK Kate, let's not tire Mr. Miller out too much. Just do a visual inspection of the penis, check the lymph nodes and do a testicle exam. They are all normal. Don't be afraid to handle the penis so you can see all sides."

Kate nervously took Dr. Lee's place and was faced with a semi-erect penis right at eye level. She looked at it and turned her head to see what she could without touching it. Internally, she took a deep breath and then gently took hold of it, pulling it up so that she could see the underside. Finally she gently squeezed the head to look in the meatus as Dr. Lee had.

She then moved the slightly larger penis to one side and took up Bill's right testicle, trying to find her landmarks.

Bill winched a bit at her touch and Dr. Lee said "Gently."

Kate felt the testicle quickly and then repeated her exam on the left one. Finally she felt for his lymph nodes.

"No lumps on the testicles and the lymph nodes were small and mobile. The visual exam of the penis was unremarkable."

Dr. Lee winched. "Unremarkable is correct for a chart note, but it's would be better to say normal in front of a patient. Sorry, Bill. Your penis is normal."

"Thanks for being a good sport Bill, now I just need you to bend over the bed so I can check your back side."

Happy that this was almost over, Bill bent over the bed and felt Dr. Lee's hands part his cheeks. After a few seconds she heard her say, "Kate turn that lamp so I have more light here." and felt her spread his buttocks even further.

"Bill, I'm going to do a digital rectal exam on you. That means I'm going to insert my finger and feel the inside of your anus. Kate, hand me that lube" Dr. Lee said, holding out a finger.

Bill was now uncertain. He hand never had anything other than a thermometer inserted back there. He had not even had and enema.

Suddenly he felt a cold finger on his anus. Then he felt a large pressure as Dr. Lee's finger went in and out of his anus several times, before he felt her fully insert it and feel around the inside of his rectum.

"Please squeeze on my finger. Like you are holding back a bowl movement."

"You can relax now. I'm going to check your prostate while I am in here. It might feel like you are going to pee, but won't."

With that, Bill feel a pressure in his rectum as Dr. Lee's finger swept over his prostate. He thought that he was going to leak another type of fluid and then her finger was withdrawn.

"Kate, please repeat the rectal and prostate exam. Bill's prostate is normal for his age. It is what you should expect to feel. Also, you should pay close attention to the feel of the anal canal. Just try to picture the structures in your mind as you feel each quadrant." Dr. Lee said stripping off her gloves and stepping back to make notes in Bill's chart.

Kate nervously stepped up to Bill and remembered to say, "You're going to feel me touch you." Before spreading his buttocks as she had seen Dr. Lee do. His anus and perianal region looked normal to her, like what she had seen in her text books. She turned her head and saw that Dr. Lee was holding out a gauze with lubricant on it and dragged her gloved index finger through it.

She then spread the patient's buttocks again with one hand and placed the pad of her lubricated finger against his anus. She closed her eyes and pushed in, concentrating on what her finger was feeling. She withdrew, rotated, and reinserted her finger 4 times to feel all of the anal canal. Then she swept her finger around the rectal vault. Finally, she reached her finger in as far as she could and tried to find the prostate. She thought that she felt it, but was uncertain due to it's small size.

Finally, she she asked Bill to squeeze her finger as she withdrew it. Dr. Lee handed her a wet wipe to clean excess lubricant from between Bill's cheeks.

"You can get up and put your gown on Bill. Thanks for letting Kate participate in your exam." Dr. Lee said.

Bill quickly got back into his gown and sat on the bed, happy to cover his semi-erect penis.

"Your overall health is fine and I am clearing you for surgery tomorrow, but I am going to suggest that you put more fiber in your diet. It is barely there, but you have the start of an internal hemorrhoid."

"You mean like piles? My dad has problems with those sometimes?"

"Yes and it is better to avoid them becoming a problem then trying to fix them. Before you leave the hospital, I'll schedule time in one of the treatment rooms to do a closer exam with an anoscope and we can have a little talk about your diet and getting enough fiber."

"But for now, you are cleared for surgery. Your surgeon does not use pre-op enemas, but he does want you to have a sleep aid for tonight. You will be NPO, no food or drink. after 9PM so don't skimp on dinner."

"Good luck tomorrow Bill. Kate, bring the cart we still have two more intake exams to do." And with that she opened the curtains and headed out.

After a couple of awkward moments, Bill said "Well that was a thing."

"You can say that again. I think I flashed Tim." Kelly added. She hoped that her breasts was all she flashed him with.

"Well at least the curtains where mostly closed. That's pretty good for Dr. Lee. The first time she examined me in bed, she dropped my gown in front of the whole room. And Bill, I don't know if it was better or worse to get the intake exam down in the bay or up here." Jenny offered up.

"Welcome to the finger up your butt in a semi-public area club." Mandy said with half a grin.

Bill thinks for a minute and then says, "Screw it. I'm going to choose to not be embarrassed by it. Or at least not be embarrassed that it was done to me."

"You sound like my brother." Jenny said.

"Sounds like there's a story there." Bill said.

"Yeah. Sam's make your own dignity story. It all started when we moved to Green Valley from New Jersey and I had gotten back from my first trip to Valley Care...." Jenny started telling the story and Kelly listened quietly.

-----

A little while later Bill was working on the assignments his professors had been "nice" enough to provide him in advance and Kelly was still thinking about what he had said, when John came in the room. He was carrying a small tray that had a paper pill cup, two syringes, and some other supplies.

John chose not to pull the curtain yet. It was a risk, but he thought that a little peer pressure might help Kelly stay calm.

"How are you feeling Kelly?" John asked, putting the tray on her night stand and pouring a glass of water from her bedside pitcher.

"Tired. Even with this, the air is still thick and hard to breath." She said gesturing and the nasal canual bringing oxygen to her.

"Well I have some medicine that will help with that. Can I see your wrist band?" John said and dutifully compared it to the medication order sheet.

"I need you to swallow this first and drink a full glass of water with them. One is loosen up the flem in your chest and the other is counter some of the side effects of the antibiotics that I will be giving you." John said handing her the pill cup and the glass of water.

Kelly looked at the pills. They were a little big, but at least they were pills and not shots or suppositories. Although, the fever suppository had not been too bad. Still she took them one at a time, putting each pill on the back of her tongue and swallowing a generous amount of water. At a look from John, she finished the water in the cup and handed it back to him.

"How are you with shots?"

"OK, I guess. I don't like them, but I'm not going to faint or scream or anything."

"Good because I have two shots for you. An antibiotic and a steroid, to help with your breathing. I won't lie, I'll do my best, but the antibiotic will hurt."

"The steroid shot is a lot smaller. I could give that to you in your butt or your arm. It might hurt a little less in your butt, but since you are going to be getting daily antibiotic shots so, I would like to spare your butt as much as I can."

"Should I use your arm or your butt for this one?" John asks.

Kelly thought for a minute. All of her shots at the pediatrician had been in her butt or, worse, her thigh. Only when she moved to the GP did she start to get some shots in the arm. Of the three sights, she actually preferred her butt. They hurt the least there. On the other hand, if her butt was to to be suffering from the penicillin shots....

Before she lost her nerve, she held out her right arm and said "Here. Use this one."

John took her arm and rolled up the sleeve. Grabbing an open alcohol pad, he cleaned a section of her deltoid. "Just let your arm dangle and try to relax." He said as he waited for the alcohol to dry.

Sensing that she was still a little tense, he said, "Close your eyes and count your breaths." After a few seconds she started to relax and he said, "Little pinch."

Counting her breaths seemed silly, but what ever. She was going to say something when she felt a little poke and some pressure in her shoulder. She was wondering when the pain would come, when she heard. "First one's one done."

Opening her eyes, she looked at John and then at her shoulder. She touched the spot where the band aid was and smiled. A little sore, but that was the least painful shot she could remember. "You're good. I barely felt that." She said.

"I try. I'm afraid that the next one will hurt more. Besides being bigger, it has some lidocaine mixed in. This will mean that it will hurt less in a couple of minutes, but it will sting more going in."

"I trust you." Kelly said as she rolled over on her belly. She reached back and opened her gown exposing a petite bottom. "If the others are going see my butt, it might as well be on my terms." She thought as cradled her head in her arms and tried to remain calm.

John looked down at the small woman in the over sized hospital gown as she bared herself. Her small athletic buttocks looked vulnerable, but her throwing open her gown without being asked made her seem more confident than many who had "faced" his needle.

He took an alcohol pad and cleaned the outer quarter of her right buttock and then fanned it to spread the drying. He removed the cap from the large boar needle and held the suringe in his right hand.

Placing his left forearm across the her back, he gripped her right buttock to spread the skin over his target and moved it slightly over. Seeing that teen was relaxed, he gave Kelly a warning. "Hold still and try to stay limp. Concentrate on your breathing. Big stick in 3 2 1" He then swiftly darted the needle into her glute.

Kelly felt the familiar sensation of the cold alcohol on her bottom. It was familiar, but John paused waiting for something? Where the nurses at her old doctors (both offices) had seemed to rush through shots as fast as possible, he took his time. She heard the big stick warning and felt a stabbing pain in her right buttock. Worse that the first shot, but not as bad as what she remembered from her last antibiotic shot.

"Now comes the owie part. Breath deep." John warned and she felt a burning in her butt as he pushed the thick medicine in.

This definitely hurt more she thought as the burning spread, but it wasn't the mule kick she was expecting. The nurses at her old doctors offices had pushed it in fast, but John seemed to take his time. Then after about 30 seconds, the pain stopped spreading and started to recede as the anesthetic took effect.

She felt John wipe the spot where the needle went in and closed her gown. He gently rubbed her bottom through the gown before helping her back over.

"You took that well." John said, cleaning up his supplies.

"It didn't ... well it did hurt a lot, but no where near as bad as I was expecting. How did you do that?" She asked remembering past encounters with no good, awful, horrible shots.

John shrugged. "You did a lot by staying relaxed. Mostly, I just don't rush. I watch your body to make sure you are ready and I don't try to force the medicine in too fast. "

It was around 4:30 and Kelly was feeling at least a little better. The sponge bath from the aid, had been embarrassing but had left her feeling a little more human. The steroids and the oxygen had eased her breathing just a bit. She had even managed to doze off for a bit.

John had just come in the room to room to take afternoon vitals and she was watching how the others reacted.

John goes to Tim first. After having his blood pressure and pulse checked, he causally rolls over on to his stomach for the thermometer, letting his gown fall open as he does. Kelly tries not to stare, but Tim's bottom and the back of his gentiles are in her direct line of sight. She looks away blushing. This was the first time she had seen a boy's bare butt, much less... This also reminded her that Tim had had a the same view of her when she had her temperature taken.

John moves on to Jenny just as she is about to go to the bathroom, so he tells her to go and he will get her last and moves on to Cindy.

Mandy is also watching this unfold. She is still uncertain about how she feels about having a male nurse. It does make having your temperature taken more embarrassing, but not that much more. And it's not her doctors aren't male and their fingers go every where. And he was really good with shots.

She was thinking about this and Jenny's story when nurse John came over to her. "How are you feeling? Any fatigue? Double vision? Nausea?" He said, wrapping a blood pressure cuff around her arm.

"No, I'm OK." She said. And she was, right now at least.

John checked her blood pressure and pulse and did the annoying follow my eyes. Then she felt him untie the top two ties on her gown and slip his hand in to listen to her heart.

"OK, I need to check your temperature. Please get into a comfortable position." John said as he prepared the thermometer.

Mandy rolled over on to her side and then after hesitating for a second continued over onto her belly. She felt the cool air on her butt as John pulled the covers down to mid thigh and separated her gown. "Well, Bill's going get a look at my butt. Only fair I guess. I got a good view of his."

Mandy blushed a bit as she felt John's fingers spread her cheeks apart, followed by the cold of the thermometer bulb against her anus. As the thermometer slid two inches into her rectum and John's warm hand settled lightly across her butt, she thought "This is not too bad. I can handle this. It's actually a little nice. Comforting."

After a couple of minutes lying there, she sighed inwardly, but knew honesty was the best policy even if it would probably add a day to her stay. "Well mostly OK. I'm a little tired and .... when I stood up too fast a while ago, the room got a little spinny. But that went away after I sat back down and closed my eyes for few minutes. And the lights are starting to get ... that look. I'm not 100% sure, but I think that I will need the cocktail after all."

"Do you need it right now? Or can it wait a while? Based on how you are feeling." John asked.

"Not right now, but within the next hour or so."

"OK. I'll go put in the call to pharmacy and they will have it up here by about the time I finish vitals. If you need it sooner, say something. I can push pharmacy to send it up stat. That means right away." John said and then Mandy felt John separate her buttocks and pull the thermometer from her. She then felt John close her gown.

"99.3. Normal." He said as he wiped the thermometer and put it a way. Then to the room, "I'll be back to finish vitals shortly." and left to call down to central pharmacy.

John returns a couple of moments later and resumes vitals. He quickly finishes Bill, who again chooses to lay on his side for the rectal thermometer, giving Mandy and Cindy a good view.

John goes over to Kelly, hoping that she will be more cooperative this time. True to his word, he treats her as the adult she is, not the bratty kid she was acting like earlier.

"How are you feeling Kelly? Has the drugs helped your breathing?" John asked while looking the girl over.

"Little better. The air's not quite so thick. I'm still tired though. Oh the bed bath felt nice."

"OK, can I see your arm?" He took the offered hand a pinched the skin on the back of the hand, judging the time for it to fall back.

"You're not too dehydrated yet, but I want you to drink more water. You're getting close to where I may need to start an IV." He admonished as he wrapped the blood pressure cuff around her arm and pumped it up.

"Mmmm, still a little low, but not too bad. Can you sit up so I can listen to your heart and lungs?" He said as he put on his stethoscope.

Kelly could feel John untie the ties on her gown and open it, exposing most of her back down to her butt. He then reached under the gown to put the bell of the stethoscope on her chest just below her breast. After a moment of listening , he moved it around her chest occasionally asking her to breath in deep or hold her breath. Finally, he moved the stethoscope to her back, but kept his right hand on her chest.

He seemed to spend even more time here, checking multiple spots and eventually removing his right hand from her chest so that he could thump on her back while listening. She was starting to get a little worried about how long this was taking when he finally took off his stethoscope and started to make notes in her chart.

"Your lungs are still pretty soggy. Not worse, but I think that it is good that we got you started on the steroids and antibiotics when we did."

"Let's check that temperature now. On your side or stomach please." John said as he shook down her thermometer. Hopefully the earlier discussion and her roommates examples would stick.

Kelly really didn't want to have her temperature taken "that way", but she didn't want to throw another hissy fit either. It had only been a couple of months since her 18th birthday and she was pretty sure that she was the youngest person in the room. None of them had objected even though they were older. I guess that I will take my clue from them and, damn it, from that Jenny girl's story.

Kelly pushed her covers down to just below her waist and rolled over onto her left side with her back to John and Bill and Mandy. She reaches back and pulls the gown out the way, exposing her butt.

"Good. It seems to have stuck. Maybe my run of good eggs hasn't ended." John thought as he bent over to lift Kelly's buttock. He noticed that she twitched a little as he placed the cold thermometer bulb against her anus and waited for it to relax. Giving it a slight twisting motion he pushed it in towards her belly button. He let her buttock fall back into place and let his hand rest against her bottom, holding the thermometer.

"I guess this isn't too bad. At least he isn't holding me place like the nurse at Dr. Jones. I hope that the other nurses are more like John than that nurse was." Kelly thought to herself. "And I have to admit that they probably couldn't get a good oral temperature on me right now."

Kelly was still thinking about what Jenny and Mandy had told her when she felt John pull the thermometer out and recover her. It was always strange that the thermometers felt longer coming out than going in she thought as she turned back over.

"103.1 Still high, but down a little bit. Keep up the drinking though." John said as he cranked up the head of the bed to make her breathing a little easier. "I am going to check on Jenny now. Rest."

John walked over to Jenny's bed. "Well, you seem to be all better. I have your discharge papers here in your chart and your Mom and someone named Lisa, will be here soon to pick you up. If they get here soon enough, we can make this set of vitals your discharge vitals"

Just as he was saying that, Jenny's Mom and Lisa walked in the room and around the curtain in front of the door. Lisa spoke up, "Getting double duty out of a set of vitals, you are a nurse after my own heart."

Jenny looked up with a smile, "Mom. Lisa. Are you here to spring me from this circus?"

"I don't know. Has she been good while she was here nurse .... " taking a quick look at his name tag, "John? And is she better?"

"Jenny has been a very good patient and a good influence on other patients. And she is much better than when she arrived. She should still take it easy for a few days and ease back into her normal activities, but she is 95% better. I'll go over her discharge instructions with you after I do a final set of vitals for the record."

"Take your time to do it right. The nurse at the desk said it would be a while for transport to arrive with a wheelchair." Mrs. Finch said sitting in a chair that was between Jenny and Cindy's beds. Lisa stood next to her, watching John work.

"OK, let's start with your blood pressure" John said wrapping the blood pressure cuff around her arm. After pumping it up and listening to it deflate, he announces "115 over 72. Very good. Now let me listen to your heart and breathing."

As he puts on his stereoscope, Jenny reaches back to untie the top two ties of her grown. John reaches into her gown and listens to her heart and then asks her to breath in deeply. Switching to the back he quickly listens to each of the four quadrants.

"Heart rate is good and your lungs are clear. I just need a temp and we are done. On your side or your stomach please." John says as he checks and lubricates her thermometer. Lisa notes the way that he gives her a choice and nods in approval and thinks how that might be better phrasing back at the office.

Jenny rolls over on to her tummy, head propped up on her arms. She feels the cold air as John opens her gown. She feels his fingers spread her buttocks wide and then the thermometer twisting it's way into her rectum. Then her cheeks come back together and she feels John's hand resting loosly on her bottom.

While waiting for the thermometer to register, John went over the discharge instructions and came out that Lisa was both a family friend and one of the nurses at Jenny's doctor.

John pulled the thermometer from Jenny's bottom, cleaned it, and read it. "99.0. Perfectly normal. I'll finish up your paperwork and you can leave as soon as transport get here to take you to the doors. Why don't you get dressed while I have your mom sign some papers." John said.

Jenny smiled and said, "Thanks for your care John. You were the best at treating us like adults even if you did come baring a lot of needles. And mmmm could you give Lisa tips on giving shots?"

"Hey! I'm pretty good at that!" said Lisa in mock indignation.

"Sorry, Lisa, but John's better. He's the best at giving shots. Everyone else agree?"

This led to a chorus of "Yep!" "I barely knew he gave me the steroid shot." "Never had an antibiotic hurt less." "He's the man." with only Bill going, "I don't know. I haven't had a shot from him yet."

"Told you. Get tips and share them." Jenny said as she went to the bathroom to change and pee.

When she came back, Lisa and John had went off to the nurses station to talk shop and wait for Mandy's meds and her Mom was talking to her roommates. She wasn't sure what they had been talking about, but she had heard her mother say, "No, it's not new. Jenny has never been good at keeping track of what trump has been played."

A few minutes later, transportation arrived. She said goodbye to her roommates and was pushed in a wheelchair towards the exit and home.