=== An Unpleasant Surprise ===

Sam Finch yawns as gets out of bed and heads over the bathroom to empty his bladder. The nineteen year old college freshman is home for Christmas break and has only a few more days before he will be heading back for the new quarter. He feels a little burning as he relives himself and looks down. He is shocked to see that his urine has a slight red tint to it. He even sees a little blood in the last dribbles.

Not sure what to do, he pats a little bloody urine from his penis with some tp and goes to ask his mother.

Mary Finch was a practical woman. She did not let bodily functions embarrass her. Looking at the red tinged urine in the toilet bowl, she turns to her son. "That doesn't look good Sam, but it is probably a kidney stone or an infection. What do you think that you should do?"

Sam looked a little like a dear in the headlights , but said "Umm... Well I told you..."

"Samuel Finch. You are 19 now and spending most of the year on your own. What should you do?" Mary was in full life lesson mode and was not going to let Sam off the hook.

"Mmm. I should ask you to make me a docto.... I mean I should call Valley Care for a doctor's appointment."

"Yes, yes you should. Or the student health clinic if you were on campus." Not being too mean, Mary continued. "Come on downstairs. I'll help you, but you are going to make the call."

Mary made Sam jot down some notes to organize his thoughts and look up the number for Valley care. "You make the call. I'll be here if you need help."

Sam dialed the number and they picked up after two rings.

Betty: "Valley Care. This is Betty how can I help you?"

Sam: "Umm This is Sam Finch. I'm a patient of Dr. Sarah. I'm home from college and I need to make an appointment."

Betty: "Sam Finch. We haven't seen you since your college physical. What do you need an appointment for honey? Are you sick?"

Sam: "Umm sort of. I had some.. My urine was red this morning when I peed. And I need to get it checked out."

Betty: "I can see how that could be alarming. Are you having any other symptoms? Pain? Nausea? Fever?"

Sam: "No, well maybe a little burning when I peed, but not much."

Betty: "Well the doctor will want to see you today. Let me see what is free on the schedule..... OK. Dr. Sarah is on vacation this week, but Dr. Kate has an opening at 1:30. We would need you a little early. Can you be here at 1:15 pm?"

Sam: "Yes, I guess I can be there then."

Betty: "OK we will see you at 1:15 for a 1:30 appointment. Be sure to drink lots of water today. Dr. Kate will probably want a urine specimen."

Sam hangs up the phone and says "I am supposed to be there at 1:15 today to see Dr. Kate."

Sam is a little nervous about this. He had mostly seen Dr. Sarah. He had seen Dr. Kate a couple of times: once when she was covering weekend house calls and once during "the Great Mumps Incident". She had been nice enough, but he had feeling that this was going to be a very embarrassing visit.

Around 1 PM, Mary pulls the car into a spot in the Valley Care parking. Turning off the engine, she turns to Sam and says, "Sam. Dr. Kate is probably going to need to do some embarrassing exams. Now you have been going back alone for your physicals for and sick visits for the last couple of years, but know that your are a little scared by this, especially with what happened to your uncle John. So do you want me to go back with you or do you want me to wait in the waiting room until after the exam. Either choice is OK."

"Umm. I think that I would rather go back alone. Many you can talk to the the doctor after." Sam said remembering the "back door" exam Dr. Sarah had given him at his pre-college physical. He was rather nervous, but he tried to be confident as he went into Valley Care and checked in before going to sit in the waiting room with his mother.

Nurse Lisa was looking at the charts for the next patient to pick up. It was a little crazy with Dr. Sarah on vacation and Dr. Kate and Dr. Jan picking up the slack. Lisa picked up the next chart in Dr. Kate's queue to see if she should set up one of Dr. Kate rooms or one of Dr. Sarah's rooms where the older patient's were taken.

She frowns a bit when she see's that it is Sam Finch coming in for blood in his urine. She had know the Finch family for a long time, back from when both her and the Finch family lived back in New Jersey. She felt protective of the trio (Sam and Jenny Finch and Sally) and tried to be their nurse, even though she mostly worked with younger patients and at 19, they would not be coming to Valley Care too much longer. She knew about Sam's uncle and was a little concerned. Well, hopefully this will just be a kidney stone. She checked the notes on the chart and went to get the supplies that she would need.

A few minutes later, Lisa goes over to Sam and Mary in the waiting room. "Good afternoon Mrs. Finch, Sam. We're ready for Sam now. Would you two follow me?"

Sam gets up hesitatingly but Mary remains sitting. "Sam would like a little privacy for the exam, so I am going to wait out here for him. I can come back after Dr. Kate is done with the exam to talk about the results. If that is OK."

"OK Mary. I will get after the exam. Sam, come on back with me and we'll get you ready for Dr. Kate." Lisa said. She would give Dr. Kate a heads up. She knew that Dr. Sarah was used to the older patients, especially the ones over 18, wanting to come back alone, but Dr. Kate usually dealt with younger ones who weren't ready for that.

Even though he being seen by Dr. Kate, Sam was glad that Lisa was leading him to set of rooms that Dr. Sarah used. They were more maturely decorated. They go to the end of the hall where there is a bathroom and Lisa opens the door. Sam sees a tray in there with a urine sample cup, some cotton balls, and a container with some liquid in it.

"We need to stop in here first. We are going to need to get a clean catch urine specimen." Lisa said as she ushered Sam in to the bathroom. He was a bit surprised when she followed him in and closed the door. Normally he was just told to fill the cup.

"Sorry Sam. We need to do a clean catch for this one so that we can get a good urine culture. It might be a little embarrassing, but it is necessary." Lisa said kindly but firmly as she put on a pair of exam gloves.

Sam blushed a bit as Lisa said. "Drop 'em. I need you to drop your pants and underwear and face me."

Sam hesitated. Lisa had been his nurse for years and taken his temperature many times, but she had never handled his privates. He tentatively unbuckled his belt and pants and left them slide halfway down his thighs. His boxers followed but his shirt still covered his penis.

Lisa sighed a bit inside and said "Sorry but this have to come down all the way." She gently pulled his pants down below his knees. She then pulled his shorts down to match. Finally, to Sam's chagrin, she folded up his shirt leaving the college freshman naked from his bellybutton to his knees.

Lisa then took some of the cotton balls and dunked them in the soapy container of liquid. "I have to clean the end of your penis to get a good sample. This will be a bit cold." She said.

Sam was still processing this when Lisa squatted down and took his penis in her left hand. Her hand felt warm and his penis started to grow. He was about to apologize when he felt the cold wet cotton ball touch his penis and it went flaccid. He tensed a bit, but she held on and used 3 cotton balls to clean the head of his penis, each time going in a circular motion from the meatus out.

"OK. I need you to pee into the toilet now so I can catch a sample mid stream. You can hold your penis if that is what you normally do but don't touch the head." Lisa said while releasing his penis and standing up.

It took some effort, but Sam managed to start peeing. Lisa waited for a couple of seconds, then moved the cup into the stream. After it was half filled, she turned her back in Sam so that he could finish in privacy while she put a lid on the cup and set it into a shelf built into a hole in the wall.

After he finishes, Lisa leads him into a near by exam room. "OK Sam, Dr. Kate is going to need to do an exam that includes your gentiles, so she is going to need you in your birthday suit. Everything but your socks needs to come off. Everything."

Sam blushed a bit, but it wasn't like Lisa hadn't just handled his penis. He decided to get it over with and sat on one of the chairs to take off his shoes. He then unbuttons his shirt and puts it on the other chair. His tee shirt quickly follows.

Standing up, Sam pauses and takes a deep breath. He unbuttons his pants and let's them fall to his ankles and, after another hesitation, bends over and pushes his shorts down. Stepping out of them, he puts them with his other clothes and hops up on the exam table to take a seat with his legs dangling down.

While Sam was getting undress, Sam was making sure that she had supplies ready for the exam. She set out an exam glove and a tube of Surgilube assuming that Dr. Kate would want to do a prostate exam. She then grabbed a small drape and turned around in time to see Sam bend over and push down his shorts.

She had to keep herself from smiling at how embarrass he looked as he tried to sit nonchalantly. She gently placed the drape over his lap and takes his wrist to measure his pulse.

"Pulse is a little high. Are you nervous?" Lisa asked.

"A little bit. I've mostly seen Dr. Sarah. I'm mean, Dr. Kate felt me I mean examined me down there last year and I was so afraid that I was going to ... you know." Sam replied.

"Well don't worry. Dr. Kate has examined her share of naked young men and none of them have died of embarrassment yet. She understands how young men's bodies work." Lisa said and she wrapped the blood pressure cuff around his arm and pumped it up.

"120 over 80. Not bad." She said joting it down on his chart. "We just need to get your temperature now. Bottoms up please." Lisa said as she turned to get the thermometer.

Even though he was 19, this was something that Sam was expecting. He had been surprised by the doctors firm rectal temperatures only policy when they first moved to Green Valley, but he had quickly gotten used to it. He wasn't exactly fond of it, but he had never throw a hissy fit over it like his sister had. Or his girl friend Sally had. They both had taken a while to get used to it.

As Sam laid down on the exam table, he turned his head to watch Lisa reach for the thermometer in the glass cylinder clearly marked RECTAL in red letters, one on top of the other. He watched her rise it off and check the reading. He was a bit surprised that she ignored the tub of Vasiline and reached for a blue and white tube. She used it and a tissue to coat the pear shaped bulb end of the thermometer in a clear goo.

Lisa walked over to Sam holding the thermometer like a little torch. She push the drape off to revel his flat muscular buttocks. "Spread you legs a bit for me Sam she said as she nudged his legs apart. She then put her left hand on his bottom and used her thumb and first two fingers to spread his buttocks apart.

Placing the tear drop shaped bulb against his anus, she saw him twitch a bit. She gave his anus a few seconds to relax adn then slowly slid the thermometer in about two inches with a slight twisting motion. She released his buttocks with her left hand and then placed her right hand gently on his bottom to stabilize the thermometer and to make sure that it did not slip in or out.

Glancing at her watch, she settled in to wait and said "Sorry if that was a little cold."

"It's just been a while since I had my temperature taken back there. Not since my physical at the end of the summer. And it felt a little different. Not bad, just different." Sam said. In truth, he kind of like the feeling of laying here with a Lisa's warm hand on his bottom. Not that he would ever admit it.

"That's probably the lubricant. Dr. Sarah prefers that we use Vaseline, but Dr. Kate prefers that we use Surgilube. It feels a little different." Lisa said. She did not have a strong preference herself, but adjusted based on which doctor was seeing the patient.

Sam heard a knock at the door and saw Dr. Kate poked her head around the curtain in front of the door right as he felt Lisa part his cheeks and slide the thermometer out of him.

"Good afternoon Sam. It been a year or so since I saw you during the big mumps outbreak. I hear that you are seeing some blood in your urine. Did that just start?" Dr. Kate asked Sam as if he wasn't laying naked on the table.

"Ummm yes. It just started happening this morning." Sam said as he sat up. He quickly reached for the drape to cover his lap for now. He wished it were bigger or that he had a gown.

"His temperature is normal. 99.2. Blood pressure is 120 over 78 and pulse was a little high at 90. We got a clean catch and it was red tinted."

"Yes, I checked in the lab. I did some quick dip stick tests and there is blood and white cells in Sam's urine. Millie is preparing a culture and running it through the centrifuge. I'll check it out under the microscope after I examine Sam here. Why don't you stay to assist Lisa. You can get a glove and such set up." Dr. Kate said, intending Lisa to be a chaperon since Sam was back here alone.

"So Sam, tell me have you had any falls lately? Been hit in the back playing sports?"

"No. No falls and I really have not had time for sports in a while. Although I still run, even if I am not quite good enough for college level track." Sam said.

"Any back pain? Or pain in your side?"

"No, no pain anywhere. Well, peeing this morning was a little uncomfortable. Like when you have not been drinking enough water. But not too bad. I wouldn't call it pain."

"All right Sam. Let's check you out. We'll start out easy with your heart." Dr. Kate said as she put her stethoscope ear pieces in and put the bell against his chest. After a quick listen of his heart, she moved it to his back and asked him to breath in deep.

She then thumped him on the back over his kidneys asking "Did that hurt?"

"Nope" said Sam as he shook his head.

"OK. Lay back. I am going to check your belly before we move to the genital exam." Dr. Kate said putting her ear pieces back in.

Sam gulped at the mention of a genital exam, but laid down on his back. He tried to keep the drape over his penis, but Dr. Kate gently slid it off and handed it to Lisa. "We won't need this for a while."

She reached down and listened to his bowl sounds and then started gently palpating his abdomen. "Try to relax, Sam. Tell me if I cause you any pain."

This was at least something that Sam was used to, although he wasn't sure how far down she was going to go.

Dr. Kate moved gently back and forth across Sam's abdomen. When she reached the bottom, she had to gently move his penis out out the way causing it to twitch. She moved back up, retracing her route but pressing harder.

"OK. Sam, I need you to stand up in front of me for the genital exam. I know this is embarrassing, but I have to do it." She said, pulling up and sitting on a rolling stool as she rubbed her hands together to warm them up.

"Mmmm yeah. I'm kind of used to Dr. Sarah, but I only had you do it that one time last year with the mumps." Sam said as he stood awkwardly in front

"Oh yes, I remember that. Well this will be a little more detailed, but I will try to live up to Dr. Sarah's standards."

"Lisa, can you point the light here for me?"

"I am going to check your penis now. I am going to look first and then feel for any lumps or bumps."

Sam blushed a bit more as he felt the heat of the lamp on his penis and felt it get a little stiffer. Then he felt Dr. Kate's warm hand on his penis. He looked up at the ceiling as felt her holding his penis in her hand.

As Dr. Kate took Sam's penis in her left hand, she noticed that he was starting to get erect, not an unusual effect of this sort of exam. "We better get this done quickly." She thought and started moving his penis so that she could visually inspect all sides. It look normal and healthy.

She then started palpating his warm penis at the base, squeezing at the sides and moving up towards the head. She then repaired this squeezing top to bottom. Next she bent over and squeezed the head so she could see in the meatus.

"All normal. I am going to check your testicles next. Are you doing your monthly self exam?" She asked as she took his right testicle in her and gently rolled it.

"Yes ma’am. Just like Dr. Sarah taught me. I even felt them today because of the blood. And they seemed normal." Sam said, trying to ignore the warm hand holding his balls.

"Good. I don't feel anything abnormal." She said as she finished with his left testicle.

Finishing with the testicles, she put her left hand on his buttock to steady him while her right hand pressed deeply in to his groin feel his lymph nodes on his left. Then she reversed her hands to feel on the right, before turning to grab an exam glove.

"That all feels good. Now Sam, I just need to do a rectal exam to check your prostate. Has Dr. Sarah done that to you before?" Kate asked.

"No. She said that she might do one at my physical this year, but she has only looked for hemorrhoids. Well she touched, but didn't.... ummm push in ... much." Sam said nervously.

"Well I'll try to be gentle. Now I need you to turn around and bend over the table." Dr. Kate said with a gentle smile as she put on exam gloves.

Lisa gently but firmly guided Sam in to position bending him chest down over the table and moving his arms to the otehr side. She quietly said. "Don't worry. It's not much different from getting your temperature taken or like when I gave you a suppository that one time." And patted him between the shoulders.

"Great. I had just about forgot about that." Sam thought as he heard a squish as Lisa squirted some lubricant on Dr. Kate's gloved finger. He then felt Kate separate his buttocks.

"You might feel like you are going to pee, but you won't. It will be a little cold." Dr. Kate said as he felt her place one gooy finger on his anus.

"You are going to feel some pressure. Just try to relax." She said before sliding her finger into his anus as far as she could. She first swept the walls of his rectum turning 180 degrees one way and then back adn 180 degrees the other. She then felt as much of his small prostate as she could reach, gently pressing on each section that she could reach.

Sam felt a lot of pressure as she pushed her finger into his rectum, much more than a thin thermometer. Next he felt her hand turning around. When he felt her push on his prostate, he was afraid that he was going to do something more than pee.

"Bear down like you are having a bowl movement." she directed so she could reach a little further. Then she withdrew her finger and grabbed some tissues to gently wipe away any lubricant she had left behind.

Snapping the gloves off, she said. "It feels normal. You can stand up and turn around."

Ignoring Sam's erection as he turned, she continued "Sam, you can get dressed while I take a look at your urine under the microscope. Lisa can go get your mother and we can talk about next steps. OK?"

"OK." Sam said, grateful to get chance to put some cloths back on and trying to hide the partial erection he had.

When she returned, Sam was sitting in one of two plastic chairs next to his mother. He was looking a little apprehensive.

"Sam, Mrs. Finch, based on my exam, Sam's symptoms, his age, and looking at his urine, I am leaning towards a kidney stone but an infection is also a possibility. I think there is a 95% chance that it is one of those two, but I am concerned that neither of them fit perfectly. Frankly, I’d be a lot happier if he had some flank pain or if I had seen bacteria. Still, here is what we are going to do."

"I'll send his urine off for culture to detect any infection and I going to write a prescription for an antibiotic just in case. I want you to finish that and drink lots of extra water. Water, not coffee or soda or beer. Water. I also want you to by a small cheap strainer and pee through it for the next few days. If you are having a kidney stone and you catch a piece of it, we will want it for the lab."

"Finally, I'm going to arrange a visit to a urologist. That's a pee specialist Sam. Given your family history, they will probably want to arrange some tests. You may have to spend a few days in the hospital for those. Even if it is just kidney stones, they are going to want to look for more. Is everyone OK with that?"

Sam and his mother both agreed and Dr. Kate said that the staff would arrange to appointment with the urologist, but Sam asked “Why does the strainer need to be cheap?”

Kate smiled, “Because you’re not going to want to use it in the kitchen after peeing through it.” causing Mrs. Finch to laugh.

Sam was quiet on the way home, thinking of a possible hospital stay and all the things Jenny had told him about her stay. He also though of his uncle who had had bladder cancer.