Marcus's Perspective

The bimanual confirmed the worrisome finding: that soft, fluctuant fullness in the right cul-de-sac, tender and boggy under my gloved finger, pressed from both sides. No fever spike yet, no rebound guarding, but the deep cramping pain she described, combined with the localized tenderness, pushed me past conservative reassessment. A small pelvic collection could be resolving on its own with antibiotics, or it could be organizing into something that needed drainage—or at least closer evaluation before it worsened in this isolated hell. With morphine nearly gone and the storm showing no sign of relenting, I had to be thorough now, while she was still relatively stable.

I cleaned my hands, changed gloves, and laid out the rest of the kit on the sterilized tray beside the couch: the bivalve speculum again, but this time the larger Graves speculum for better visualization; a long cotton-tipped applicator for swabbing; a 10 mL syringe with saline for gentle irrigation if needed; a small flexible sigmoidoscope (short version, battery-lit, the one I kept for emergency proctosigmoidoscopy in the field bag); sterile lubricant packets; and a set of ring forceps and biopsy forceps just in case I needed to sample or grasp anything suspicious. It looked like a small OR setup on the coffee table—overkill in a normal hospital, but here it was necessity.

"Emma," I said quietly, sitting on the edge of the couch so our eyes were level, "the area I felt is tender and full. It's small, but I need to look closer and make sure it's not collecting more or showing signs of infection that we can't see from the outside. That means another pelvic exam—deeper, with more instruments so I can visualize and maybe irrigate the area gently. It'll be more invasive than before. I'll go slow, explain every step, and stop the second you say stop. But I need you to try and stay as relaxed as possible. Can you do that for me?"

Her face paled, fresh tears gathering, but she gave a small, trembling nod. "I… I trust you. Just… don't leave anything out. And keep talking."

"I will. You're so brave, Emma. Most people would have shut down by now. Breathe for me—slow in through your nose, out through your mouth. Good girl."

I helped her into position again: flat on her back, hips slightly elevated on a folded blanket, knees bent and parted, feet planted on the couch. I draped her with a clean sheet for as much modesty as the situation allowed, then uncovered only the necessary field. Her breathing was already shallow, anticipatory.

First, external exam—gentle parting of the labia with gloved fingers, inspecting the introitus and perineum. Mild swelling from yesterday’s manipulation, no new bruising. "Everything looks okay externally. Now the speculum again—I'll use the larger one this time for better view. It'll feel cold and fuller. Breathe for me… in… out…"

The Graves speculum slid in lubricated and slow. She hissed as the blades parted her vaginal walls, the stretch more pronounced than with the smaller one. I locked it open carefully, the click loud in the quiet cabin.

"There we go… almost set. You're doing beautifully. Just relax those muscles—let them soften." I angled the light, peering in. The posterior fornix still showed that subtle erythema, and now, with better illumination, a faint bluish hue beneath the mucosa—possible small hematoma component. No active bleeding, no pus pooling at the os, but the right lateral wall looked slightly boggy.

"I'm going to swab the area now—long Q-tip, just to check for any discharge or odor." I passed the cotton-tipped applicator deep along the right side, gently rotating. She whimpered, hips twitching involuntarily.

"Sorry, sweetheart… almost done here. Breathe through it. Good… good girl." The swab came back with a trace of serosanguinous fluid—clearish with a pink tinge, no foul smell. Promising, but not definitive.

"Swab looks okay—no obvious pus. But I want to see higher and make sure nothing's tracking from the rectal side. I'm going to switch to the sigmoidoscope now. It's longer, flexible, lighted. It'll go in through the rectum and let me look up toward the pelvic area from below. It'll feel strange—pressure, maybe some cramping—but I need to rule out a fistula or deeper collection."

Her eyes widened in panic. "Through… the back?"

"Yes. I know it's a lot. But you've handled everything else like a champion. This is the last big step today, I promise. Breathe for me again—deep and slow."

I withdrew the vaginal speculum slowly, earning a soft, relieved exhale from her. Then I helped her roll onto her left side once more, right knee drawn high, left leg straight. I lubricated the sigmoidoscope generously—the thin, lighted tube about the diameter of a finger but longer.

"Small breaths… here we go." The tip pressed against the anus, gentle but persistent pressure until the sphincter yielded. She cried out softly as the first few inches advanced, the stretch burning.

"I'm in… just a little more. You're so strong, Emma. Almost there… relax for me, let it slide." I insufflated a tiny amount of air to open the lumen, advancing under direct vision. The rectal mucosa appeared mildly inflamed but intact. At about 12 cm, I angled toward the right anterior wall—the same area I'd palpated earlier. There it was again: extrinsic compression, a soft bulge pushing in from the pelvic side, mucosa overlying it intact, no fistula opening, no ulceration.

"Found it," I murmured. "Same tender spot—bulging in from outside the bowel wall. No hole, no pus draining. Looks like a contained collection pressing on the rectum. That's why the deep pain is so bad."

She was crying quietly now, body trembling from the discomfort and the emotional weight. "Is… is it bad?"

"Not catastrophic. Small, contained. No free perforation. We're going to keep treating it with antibiotics and watch it closely." I slowly withdrew the scope, millimeter by millimeter. "Almost out… there. All done with that part."

I cleaned her thoroughly with warm cloths, then helped her roll onto her back again. No need for more instruments today—the findings were clear enough to guide management without escalating to blind drainage in a non-sterile cabin.

Emma's Perspective

The relief when the scope finally slid out was overwhelming, even though every muscle in my pelvis ached and burned. Tears streamed down my temples into my hair. The invasion had been total—cold metal, stretching, pressure from every direction—and yet his voice, low and steady, had kept me tethered.

"You were incredible," he said, pulling the sheet up and tucking it around me before sitting close, one hand cradling mine. "I know that was really hard. Really invasive. But you let me see everything I needed to see, and now I know exactly what's causing the pain."

I turned my face into his palm, still shaking. "It hurt… so much. Felt like… like I couldn't breathe sometimes."

"I know." He brushed damp hair from my forehead. "Rest now. The last of the morphine is going in soon. We'll manage the rest with what we have. I'm not going anywhere."

Marcus's Perspective

I drew up the final half-dose, pushed it slowly through the IV, watching the tension in her face soften as the opioid hit. She was exhausted, emotionally and physically raw, but stable. The collection was small, contained; aggressive IV antibiotics should handle it until roads cleared. And in the meantime, I would monitor her like she was the only patient in the world—because right now, she was.