“Let’s get back to the pain in your abdomen,” Mervyn said. “Okay if I examine you?”

I told him yes, it would be nice if I could understand more of what was happening, and he helped drape me once more and warmed his stethoscope and hands.

Mervyn gently supported my shoulder. “Let’s lay you back one pillow’s worth,” he suggested, removing one, helping lean me back slowly, and then pulling up the covers more to my hips.

“Time for a listen,” he said, and I felt the still somewhat cool diaphragm of Mervyn’s stethoscope press lightly on my skin over my bowel. “Light percussion now,” he said, placing a hand over the painful area and starting to tap. He went through the rest of my bowel and then returned, tapping again, over my right lower quadrant.

“Let’s have a feel, now. I’ll start away from your pain with medium pressure and work my way there. Tell me if you feel any discomfort or pain, please.”

Mervyn’s fingers pressing my left side were okay, but as they glided and pressed right it hurt. He re-approached my right side, pressing on my gallbladder.

“That okay?”

I nodded. “That’s fine.”

“And here?” He watched my face.

“It’s tender.”

“Here?”

“More tender.”

“I’m going to use some deeper pressure now, apologies in advance if this hurts.”

He started left, and even that was a little sore.

“I guess my whole bowel is tender.”

“I’m sorry. Take a nice deep breath and relax, and we’ll start again as soon you’re ready. Let me know if the pain changes as I apply pressure?”

“Ready. Oh, that hurts. Uh, that too. Even after you stopped.”

“I’m sorry, Sandrine. Really, I am. Take a moment, but I need to test you for rebound tenderness.”

I nodded, and he pressed deeply at McBurney’s point. The release didn’t hurt, after which we both relaxed. I waited for Mervyn to offer anything, which he did not.

Finally I asked. “It hurt a lot more with pressure, surprisingly more. What do you think is happening?”

“Well, short of being able to get you an MRI or even an X-ray, neither of which is clinically indicated right now, I think you’re having a very mild viral colitis, enough to irritate you but not enough to cause diarrhea. That’s the generalized pain on deep palpation. Where the pain can be felt on its own and worse with light pressure, I think that’s right-sided colonic spasms, with a bit of a backup of gas and stool because of them, both of which can cause significant pain.”

“That new, sharper pain that fluctuates when you breathe—“ here he pointed exactly to my new pain, “That may be an inflamed mesenteric lymph node secondary to the mild colitis. So none of it’s very fun, I’m sorry, but with the symptoms you have now, nothing of concern for an acute abdomen.”

“Sorry. I appreciate your taking the time and all your care very much. Just, sometimes, I wish this was an easy, one-time surgical fix, like appendicitis, after which I’d feel normal again. Having a new pain made me wonder if this was finally the time there’d be a solution. Now I feel stupid being disappointed I don’t need emergency surgery.”

Mervyn squeezed my arm. “No need to blame yourself for how you feel. You go through an awful lot of pain and suffering, and I’m so sorry that happens to you. I’m certain I would feel the same way myself. But tonight, the very best thing we can do is make you as comfortable as we can and get you to sleep. Let’s get you heat packs right now, and I’ll fix your enema, and we’ll see if we can’t have you more comfortable soon.”

Everything in my abdomen felt terribly stirred up after the deep palpation, and when Mervyn tucked a hot pad under my back and draped one across my belly, the initial relief was blissful.

“I’m so sorry. I should have asked you about bowel symptoms and gotten you hot packs right away. I knew you were stoic, but not how much. And please, please, tell me, if you can.”

“Mervyn, it’s okay. You helped my cough. And I didn’t realize this was so bad until you palpated me. It was a 1-2 on the pain scale before. You’re helping now.”

He returned with the enema can, asked me to roll over, and snapped on a glove. “Time for lubricant. Tell me if I’m causing pain.” He very gently pressed a fingertip to my anus. “We’re going to go very slowly today.” He entered me a little at a time, pausing, asking for feedback, then entering deeper.

As bad as I felt, it didn’t hurt that way, and eventually his finger was all the way in. “Okay, same approach, let’s lubricate your rectum now, gentle and slow.”

I was focused enough on my abdominal pain that this was not as thrilling as some previous times, and no embarrassing noises escaped. As Mervyn angled laterally, there was a moment of pain.

“Sorry! All done now.”

Of course it was then that I started coughing, with Mervyn’s finger still in my bottom. This hurt, was embarrassing, and was funny all at once. Mervyn used the longest pause between coughs that I could engineer to withdraw his finger. Off came his glove.

“Let’s sit you up.”

The coughing stopped.

“Try rolling over again?”

The coughing started anew.

“Up, up, up. Okay. Let’s do something different. Let’s have you on your side just long enough to insert the nozzle, then have you sit propped up for the fill, okay?”

I nodded, still coughing.

Mervyn waited for me to catch my breath, then had me roll left, inserted the nozzle as I coughed, and helped settle me propped on two pillows, after which the cough stopped.

It was a little more strange and intimate to make eye contact with Mervyn as he pumped the water into my bowel and massaged my abdomen.

“How is that feeling? Where’s the pain?”

“It’s helping the generalized pain. My right side hurts and I feel a little nauseated.”

“Think you’ll be sick?” Mervyn eyed the bowl on the dresser.

“Probably not. Please keep going?”

Mervyn gave a few more pumps. My belly looked very distended. Nausea made me swallow, and my right side continued to feel tensed and painful. This was the worst of both worlds.

“Not good. I know,” said Mervyn. “I’m sorry. Your ascending isn’t filling in this position. I’m not giving you more water like this; we’re just stretching your transverse and descending colon. We’ll try some massage but might need to tip you right, even if you cough.”

Mervyn used two hands at once, one sweeping deeply over my hepatic flexure and the other sweeping deeply across my transverse colon.

Fighting a strong wave of nausea, I groaned aloud in pain. My lopsided belly stayed very distended everywhere but my right side.

“Oh, Sandrine, we can’t just use massage. You’re too spasmed. I’m so sorry. Roll right please, for as long as you can.”

I rolled to my right side and coughed continuously as Mervyn massaged. Finally something moved.

“Okay, back up. Up, up, up. How’s your pain?”

“It’s better,” I said as soon as I could speak. The distention had lessened and equalized.

Mervyn nodded and gently massaged my right side through the hot pack. “Any pain here?”

“It’s sore like the rest of my bowel but doesn’t hurt badly.”

“Let’s try for as long a retention as you can handle. Absorbing a little water will help with everything that’s going on with you, including loosening your chest.” Mervyn swept water deeper in shallow strokes across my whole colon, and my nausea faded. His touch felt very comforting, and having a man’s hands on my lower abdomen felt unintentionally intimate.

I closed my eyes and focused on the sensation. Sick as I was, I could feel myself getting very wet, but I had to admit that Mervyn’s remoteness had always given me pause in imagining him as a romantic partner, despite his being attractive, caring, and the purveyor of excellent enemas. It was just a physiologic response I was going to have to ignore for professionalism’s sake.

Mervyn took in my expression. “Do you need, um, a moment?”

I froze. Was he on to me?

“I hope this isn’t an overstep. Even as an ace, I find receiving enemas, even medically necessary enemas, arousing. If you feel the same and want to enjoy, I can step out momentarily?”

I thought about protesting but decided to just go with it and nodded.

“Text me when you’re ready?”

I nodded again and watched Mervyn leave. I brushed a hand under the hot pad and covers, where I gushed moisture. I began to stroke my labia, which felt fantastic. My back arched as I touched myself, pressing faster and harder into a wonderful crescendo that made me both wheeze and moan. I lay, panting, then with my clean, non-dominant hand, texted Mervyn that it was okay to return.

Without a remark, he checked his watch and took up his gentle massaging of my belly. “If we can keep this in you for ten more minutes, you’d benefit.”

“Thanks for not making me feel weird,” I said as his fingers patiently swept my ascending colon.

“Of course. I’ve used them myself for years and found they made me feel a certain way since puberty. That was how I knew puberty had arrived.”

He helped me through a cramp, giving firm counterpressure and asking me to breathe.

“Thank you, Mervyn. For everything.”

Another cramp hit, and I inhaled sharply, which made me cough. I started to worry I’d lose the enema right there in bed onto the waterproof pad.

Mervyn stopped massaging my abdomen and started rubbing my chest, which seemed to calm my airways and cough. “You feeling ready to expel? You’ve held it long enough to have some benefit.”

“I think I can hold a little longer.”

“Okay, then just relax.” Mervyn reached underneath me and massaged my sacrum, and then released more tension from my belly.

“You’re excellent at massage,” I told him.

“Thank you.” He chuckled. “I was a constipated kid and had to learn on myself.” He placed the flat of his hand on my enema-filled abdomen. “You’re tensing. Deep breaths to meet my hand, okay? In, and out. Good.” He checked his watch. “You made it. Let’s massage you in the direction of peristalsis now. If my guess is correct, you’ll need to roll left to get that going well. So let’s start the massage and then I’ll tell you when to roll.”

I rolled left and started to cough immediately.

“Into a long steamy shower the moment after you release, please,” he said over my quiet choking, and helped me up. “But maybe sit on the bench? I’m a little concerned you’ll be woozy. I’ll be inside, not right on top of you, but here in the sitting area. Please call out if you need.”

I did feel a little worse for wear while releasing, and again in the shower but took Mervyn’s advice and sat, with my head between my knees at one point, which made me feel better. I wrapped myself in a towel and came straight to bed.

Mervyn helped prop me up and settled the covers over me. He brought me water, saying I was probably still a bit dehydrated.

“It’s 11 PM,” I realized. “You shouldn’t feel you need to stay.”

“I won’t stay long, just until you fall asleep.”

Sleep came quickly, and I didn’t even hear Mervyn letting himself out. My gear was clean and put away when I got up the next morning.