Making time for the appointment requires patience. A workday I can clear of meetings is rare, and it is nearly two weeks after Brian first sends the photos and short video of my custom nozzle that I can schedule a full Friday out of office. Truthfully if not transparently, I tell my manager I’ll be out for a “medical procedure.”

On the planned day I awake tired, although I can recall no long periods of wakefulness. A slight, grinding ache registers in my abdomen; a touch of nausea thickens the back of my throat. Nothing, in my life with IBS, at all unusual. Reviewing my diet of the day before, no indiscretion leaps out, also not new.

Drinking tea settles my stomach and helps open my bowels, which seem to work well enough. The colonic ache persists, perhaps more strongly, but this, too, is familiar and often improves as days wear on. With a flat hand, I lightly massage my belly. Finding no point tenderness, I take a few deep breaths to relax before getting on with my day.

The day is as clear and pretty as the weather had been for my fitting, a bluebird sky, gusts of summersweet blossoms in the air as I bring a piece of toast out onto the back deck. I want something in my stomach, but not so much as to interfere with the enema Brian will later give me.

“Brian will give me an enema,” I repeat silently, smiling.

I wonder if there’s been too much buildup to this day. For my fitting, I was blindsided by how attractive I found Brian, how bright, tender, and winsome, and I was further shocked to see no evidence of a Mrs. or Mr. Brian: No ring or tan line on the ring finger, no evidence that a second vehicle parked next to the cheery farmhouse.

Now I’d had a full month to dwell on these things, especially the moment at the end of our time, his enigmatic flash of smile and offer that I could test the nozzle before completing the purchase.

Did he offer this to every client within driving radius? With a confusing nanosecond of warm smile?

Either way, an intelligent, handsome, gentle man is going to give me an enema, and I do not want to kill the vibe, especially if it turns out to be a second afternoon of pure professionalism. I resolve to enjoy the moment without overthinking about its likelihood of developing beyond the moment.

I shower, careful to shave everywhere, but choose a dress without too much thought, leave my hair down to air-dry in the car, and apply minimal makeup. Trying too hard would definitely make it weird, and I am not going to make it weird.

The first half of the drive is easy; my timing misses the city traffic, and the sunlight striking the agrarian landscapes that come next is beautiful, the stuff of a classic late-summer day. Save the six-lane highway, the view could be from 70, 90, or 100 years ago, a feeling I love.

Two and a half hours in, I’m hit with a feeling I do not love. The abdominal pain, about which I’d forgotten for a while, is back and getting sharper. It radiates into my lower back as nausea forces me to swallow, hard.

I roll my eyes. Arriving in a full-on IBS flare is definitely going to make it weird.

I lean forward as I drive and try deep, diaphragmatic breaths to release the tension building in my lower abdomen. Giving up on that, I lean back and turn on my car’s heated seat, grateful even in summer for this piece of its winter package.

By 30 minutes out from Brian’s farm, I admit to myself that I feel horrible, in significant pain and very systemically sick, consistent with the worst IBS flares. I want, intensely, to lie down and be still.

While I wonder if should turn around and go home, I can’t face it. I decide, worst case, that I will explain, pick up the nozzle, and ask Brian to just let me rest before driving home. The shop has a bed, and I will have bought the time, so this seems fair and reasonable.

Happy to at least have a plan, I white-knuckle my way through the rest of my drive. I no longer care about making it weird, and focus only on making it.

My relief at reaching the gravel parking area is soon overtaken by the length of the walk to the shop. I have to pause in the pine grove to lean against a tree, and by the time I reach the clearing I want to stop again, but with nothing to lean on I force myself onward.

It seems like forever before I am knocking on the rolling door.

Brian opens it, smiling, again in a fitted tee and jeans. He gets about as far as hello, and then nothing goes to plan.

“Are you okay?” he says, placing a steering hand on my bicep. “You really don’t look good.”

I shake my head and explain an IBS flare hit me out of basically nowhere, while he guides me to his rolling computer chair on the shop floor. I sit. Squatting to be at my eye level, he asks me about my symptoms, which I recount.

“Could I just pay for the nozzle and rest here a bit before starting home?” I ask.

He shakes his head. “Not to argue or be too mother-hen, but is this really what these flares are like for you?”

“Not every time, no, but they can be this bad.”

He shakes his head again.

“Because I’ve spent seven years, off and on, in emergency medicine, and to me you look like someone who should go in, now, and be evaluated for an acute abdomen.”

“Memorial is less than 25 minutes away and staffed by excellent people, most of whom I know.”

His eye contact is pleading, and he gives my forearm a meaningful squeeze.

“I would drive you.”

“I would stay with you and ensure you get the best care. Let me get my keys?”

I’m on the edge of too sick to negotiate but not over it.

“But I’ve done that before. Had the clean CT, not been admitted, and been sent home hours later feeling just as bad. The only things that have ever helped are throwing and going from the oral contrast solution, which I wouldn’t recommend to a dead dog, or taking an enema.”

I see my argument land, if not with a flourish.

“Looking at you, I’m not convinced, and your life and its value aside, I don’t want to risk my professional reputation. I think it best for you to have abdominal and pelvic imaging. And I will personally assure that you get pain control and anti-nausea meds.”

I always tough out these episodes, and while I plan nothing different this time, it doesn’t stop a quick reverie of a pharmacologic break from the misery. But I snap myself out before Brian can think he has a toehold.

“Please, I understand your not wanting to risk your reputation, and I’d never ask. Just let me rest here for an hour so I can drive home and take an enema there? I know how bad this looks, but after 30 years of IBS I know my body and what makes it feel better.”

Brian shakes his head at me.

He sighs.

“No, I’m not that guy. I’m not going to let you lie here, sick and in pain, possibly having a medical emergency, just so you can turn around and drive four hours, alone.”

Then he shakes his head again, with a wry look suggesting that this time it’s at himself.

“I’ll help you—if you agree to two things.”

“One, and I am serious about this, I need you to sign a written waiver that I am helping you in a personal, not a professional capacity, and that you do not hold me personally or professionally liable.”

“Two, that you let me exercise medical judgment. And if we get data points along the way that say you should be seen in the emergency department, or if you’re not feeling a great deal better when we’re done, then I’m bringing you to Memorial. Without argument.”

“Or, I could still take you there, right now.”

He looks at me pointedly, but I don’t engage.

“Oh, and make that three. You are NPO starting this minute. No food. No drinks. Not even a little water, not even if you are very, very thirsty.”

“I’ll sign a waiver. And yes, if this isn’t IBS I will gladly accept your offer of a ride to Memorial and your advocacy in the ED. And I won’t do anything to make myself aspirate if I’m wrong and need surgery.”

He helps me to the bed, tells me to undress to just my bra and underwear, and to hang on while he gathers some things from the house.

Even though it shouldn’t matter, I find myself glad to be wearing a pretty bra and panty set in deep hunter green. I climb slowly and gratefully into the bed where I can tuck into the fetal position under the covers. Fifteen or twenty minutes go by and Brian returns with a waiver on a clipboard and a black backpack.

“Sign here? Initial here? And here? And date here? It’s the 20th.” I do, and he sets the clipboard aside. “Next, data points.” He reaches into the backpack and pulls equipment out onto the bed. There’s a blood pressure cuff, a stethoscope, a pulse oximeter, and a thermometer.

“Index finger?” He clips on the oximeter.

Next he opens the thermometer case and shakes down an old-school mercury thermometer. “Going to surprise you,” he laughs. “It’s oral. Under your tongue, three minutes.” I see him set a timer on his phone.

He unclips the oximeter. “Your sats are good, but your heart rate is high.”

His phone beeps and he reads my temperature. “You’re febrile,” he says, shooting a meaningful look. “101.2.”

“Hey, you won’t believe me, but that happens when it’s bad. And my neutrophils go up.”

I think I see him roll his eyes.

I hear the rip of Velcro and he requests my arm for the blood pressure cuff. He pumps it up and cradles my arm gently while waiting for a reading. “Elevated, as expected when you’re in distress.”

“Virtually nothing inconsistent with an acute abdomen.”

“Examine me. You won’t find rebound tenderness. No one ever does, no matter how bad the flare.”

“I’m supposed to be happy you’re only on the road to peritonitis and possible septic death, not there yet?”

His face softens. “Look, I banter because I care. Scoot down a little and lie flat, please?”

It hurts to move, which I am now trying to keep off my face to help me “win.” I’m not cold, per se, but I feel myself shivering, another fun thing that can happen during flares but also seem like perforation, and I try to hold still.

I think we both realize, at once, that this is no way to go into an abdominal exam.

He touches my shoulder. “You’re in a lot of pain,” he says. “Arguing isn’t the fastest way to help you.” I see his expression become tender and think we may be getting somewhere but now feel very chilled and can’t hold back another shiver. Which he feels.

“F***, are you seriously also having rigors?”

“Yes, but—“

“But this also happens to you during flares? Really?”

I nod, miserably, shivering uncontrollably now. “At least half the time.”

“I could call and speak with the attending right now. You wouldn’t have to wait. We’d arrive and they’d take you straight back. Say the word.”

“This happens with flares.”

I see something in his brain open up, finally imagining what it’s like to be me if all this is true. “What do you do?”

“Hot water. Shower or bath. Only thing that helps quickly.”

He gestures to the bathroom. “I’ll get the shower warm now and be right here if you need.”

I come back to the bed, hair and body wrapped in towels, and shrug under the covers. Brian helps pull them up and puts a comforting hand on my shoulder. “Stay warm. I’ll drape you as I go.”

I lean into his touch and nod gratefully, knowing we’re now working as a team.

Brian helps me to lie flat for the abdominal exam and drapes me with two extra blankets. I hear him warming his stethoscope.

“Tell me where you feel the worst pain?”

“McBurney’s.”

He receives the information without gloating. “Does it hurt anywhere else?”

“Into the ascending colon. But my whole lower abdomen aches and refers into my back.”

“I’ll be as gentle as I can.”

I feel him listen quickly for bruits and then much more slowly for bowel sounds.

“Light touch now,” he says, percussing.

“More pressure. Tell me if anything hurts.”

Everything feels at least sore, and I tense under his fingers even as I try not to. He feels for Murphy’s sign, which causes me no additional pain, and then begins light palpation of my lower right side, which is tender. In the end I don’t have to say a word, as he correctly recognizes what causes me distress and how much.

My eyes tear up when he presses at McBurney’s point, but as usual there’s no increase in the pain when his hand releases. Deeper pressure in my right lower quadrant makes me wince, and I can see him trying to make it quick.

“Relax, that’s over,” he says, covering me back up and sitting at the foot of the bed.

“You have point tenderness that to me seems inconsistent with IBS. It could be consistent with an appendicitis or a partial blockage of your bowel.”

“I know,” I say. “And that’s what I’d think if this hadn’t happened at least seven times before.”

“Seven?” He touches my leg sympathetically.

“At minimum. After a while I try to block those memories.”

“I was scared the first time and had the workup. Everything except the imaging supported an acute appendix. Since then I’ve ridden these out and ended the flares with enemas.”

“We’ll try one,” he says, emphasizing the “one.” “Warm water and baking soda?”

I nod, thinking how knowing my enema recipe is similar to knowing how I take my coffee or tea, a small, domestic intimacy.

Brian disappears into the bathroom, and I hear water running. I’m hit with another wave of nausea that has me wondering if there’s still toast and tea to bring up, although that seems unlikely. All I can do is breathe.

Brian hangs the can and asks me to assume Sims. I feel his supporting hand on my hip.

“Ready to be lubricated?”

“Yes,” I whisper.

“Inhale?” His gloved finger enters me and produces a zing of referred pain across my belly that makes me stiffen.

“That pain is also consistent with an appendicitis,” he says quietly.

“Another deep breath?” I feel a nozzle enter me easily and seat deeply but comfortably.

“Mine? If so, your work is excellent.”

“It’s yours. Ready for water?”

I nod. He runs the water in more slowly than during the fitting.

“Should I massage you?”

“Please. I need it most like this.” I feel him work the water up my left side and across my transverse.

“Right lateral?” he asks tentatively.

“Yes, but it’s going to hurt a lot at first. It always does, without causing a perforation. Please massage my ascending and back once I turn? I’ll need it badly.”

“Okay, I’ll try.”

He helps me turn and the resulting pain causes me an involuntary whimper. I feel his hands work the water in and release the tension in my back, and then the pain and nausea stop. My shoulders relax.

He watches my face, incredulous.

I take a tentative deep breath. It doesn’t hurt.

“Thank you. It worked. That’s how it works. There will probably be more cramps before I finish the expulsion, but the constant pain and nausea are gone.”

He helps me with more massage after all the water has run in, touch as deft as before. There are about three waves of painful cramps, all of which he tenderly helps me through, and then I expel, seemingly completely, and shower.

“I just used your last bath towel,” I apologize as I get back into bed, wrapped in it.

“That’s fine.” He looks at me appraisingly. “You’ve been through a lot today. How about you rest? I’ll be on the shop floor if you need me.”

I sleep for three hours, waking only when Brian apologetically needs to use the bathroom. When he emerges, he asks after me.

“I can’t describe how much better I feel.”

“You have color now. May I collect more data points? I’d like to be sure this isn’t a brief reprieve.”

My temperature, sats, heart rate, and blood pressure are all normal, and he asks to examine my abdomen.

“Normal bowel sounds everywhere.” He goes straight in for deep pressure at McBurney’s point, which now doesn’t really bother me at all.

He shakes his head. “I’d swear you were partially obstructed. You were so pale and ill-appearing. And now you seem fine.”

“That’s what this can be like,” I say.

“And you usually handle this on your own?”

“These past several years, yes. Sometimes it takes multiple tries, but eventually I get it.”

“I really don’t like the idea of your being alone with this. I worry your bowel could eventually rupture.”

“What am I supposed to do?”

“If this happens and you’re alone, can you let me know? As a friend? At least I can check in on you from afar.”

“Thank you for your generosity. And for caring. I’m really unable to express the depth of my gratitude.”

“You’re easy to care about,” he says, watching for my reaction.