Meghan closed her eyes, wondering what she’d gotten herself into. She could hear her sister and brother-in-law talking in low voices, with cryptic comments flowing between them in snatches she couldn’t quite catch. She started when Kelsey touched her arm. “Sis, we’re about ready. Would you like some warm socks for those cold toes?”

Meghan nodded and was so relieved at the envelopment of her cold feet with the warm socks. She also welcomed the warmed blanket that was draped around her shoulders as Kelsey removed the now-cooled other blanket.

Mitch came back by the bed, sitting on the stool. “Meghan, I think we’re ready on our end. Shall we begin?” Meghan hesitated, then nodded.

Mitch hit the footswitch that started the bed into motion again, bringing the bed to normal exam height. He left it with the back raised but leaned her back a bit. “Meghan, I’m going to do a full gyn exam, minus the parts that I did earlier. I’m going to untie the back of your gown, and I’ll need you to let it fall into your lap for a breast exam.” Meghan’s eyes widened, but she didn’t complain as he untied the gown.

“Okay, now let it fall into your lap, Meghan,” Mitch encouraged. She slowly lowered the gown to her waist, removing her arms from the sleeves, and exposed her breasts to her brother-in-law.

“Good. Meghan, I want you to sit up straight and puff your chest out… now hands on your hips and bring your shoulders forward… and bring your arms behind your head. Good. Keep this one behind your head.” Mitch had come to her right side. He held her right arm with his left hand while using the fingers on his right hand to feel first the lymph nodes in her axilla before moving to trace small circles around her right breast, gently but thoroughly kneading the breast tissue.

“Go ahead and put this arm down, and raise the left arm above your head.” Meghan switched arms, and Mitch repeated the same exam on the left side.

“Looking good, Meghan. I’m going to lay you back and repeat the exam with you lying down.” Mitch moved the bed down so she was reclined, but not fully flat. “Left arm behind your head, please.” Mitch repeated his exam procedure on her left breast, finishing with a quick squeeze of her nipple to check for discharge.

Meghan, who had her eyes closed to separate herself from what was going on, gasped, her eyes flying open.

“Sorry, just checking for discharge. If you’ll switch hands, I’m going to examine your right breast again.” Meghan dropped her left arm by her side and put her right arm behind her head. As Mitch resumed the exam, he asked, “Do you do self-breast exams every month, Meghan?”

Meghan was embarrassed by the question, but steadily replied, “Yes, around my cycle.”

Mitch finished his examination of her breast, squeezing her nipple, and grasped the neckline of the gown on her stomach. “Everything seems fine, Meghan, so far. You can put the gown back on.” She accepted the material from his grasp and slipped her arms back in the sleeves. She wrapped the warm blanket back around her shoulders and waited for Mitch’s next move.

“I want to palpate that sore spot once more, Meghan, before we move on.” She nodded, and he raised the hem of the gown above her belly button, pulling the drape down so that it barely covered her mons pubis. He lightly ran his hand across her stomach, stopping just above the right side of her pelvis. “Is this the area?” Meghan nodded again. “I’m sorry, but this will probably hurt. Bear with me for just a minute, okay?”

Meghan gritted her teeth and nodded her consent. Mitch pressed down over the painful area, while Meghan hissed through her teeth. He prodded deeply for several seconds while she tried not to squirm. She was very relieved when he was done.

“Sorry to have to cause more pain, hon. Do you need something for it?” he asked, apologetically. Meghan didn’t immediately respond. She tried to shake her head no, but the tears streaming down her face belied her actions. “Kelsey, draw up Zofran and Morphine and give it IV push. Meghan, honey, let’s get that pain under control and get you comfortable. I’m probably going to hit that spot again when I do your pelvic and don’t want to cause more pain than necessary.”

Kelsey brought over the meds and administered them through Meghan’s hep-lock. Meghan felt the pain relief ooze through her body, followed by the fuzzy feeling that Morphine inevitably brought.

“Better?”

“Yeah, thanks.” Meghan wiped at her tears.

“Good. Meghan, the next part is the pelvic exam. I’m going to use the knee supports, as I think it’ll be much easier to balance your leg on one of those compared to the stirrups. Give me just a minute to set up the table, here, and we’ll get you into position.” Mitch and Kelsey brought over the supports and attached them to the table. Mitch helped negotiate Meghan’s splinted leg to rest against the left support while Kelsey guided Meghan’s good leg into the support on the right.

“Scooch your bottom down, sis. More… more… right there.” Kelsey adjusted Meghan’s gown and the drape to cover her for the moment. Meghan heard gloves being snapped on, a tray being moved close to the end of the bed, and the sound of the wheeled stool coming close.

Mitch stepped into her line of sight. “Okay, Meghan, you’re going to feel the end of the bed drop away,” he stated, while the bottom of the bed lowered. She suddenly felt her bottom hanging off the end of the bed, feeling rather exposed underneath the thin drape that would soon be removed.

Mitch positioned the light to better illumine her and sat down on the stool between her legs. He lifted the drape, settling it across her lower stomach. “Meghan, I’m going to begin the exam now. You’ll feel me touching you.”

With a warning touch to her inner thigh, Mitch placed his fingers on the outside of her labia, palpating first the lymph nodes of her groin. He then grasped her labia and separated them, exposing her inner labia, vaginal introitus, urethra, and perineum. He shifted his hands lower and separated her again, then lower, taking a cursory look at her anus.

Moving back to her labia, he carefully palpated along her labia majora, then her labia minora. He did a quick inspection of her clitoris and clitoral hood, then felt along her urethral opening. He slipped one finger just inside her vaginal opening, milking the glands there for discharge. “So far so good, Meghan. One quick question before I go further: do you need to empty your bladder?”

Meghan thought for a second. “Yeah, I could stand a chance to go.”

Mitch nodded at Kelsey. “It felt like your bladder was full, which I’m sure could be uncomfortable. Kelsey will do a quick straight cath since we’ve already got you in position.”

Meghan just buried her face in her hands, but she acquiesced. Kelsey put a sterile straight cath kit on an empty Mayo stand and brought it up to the bed, Mitch having moved away to give her access. Kelsey opened the pack with sterile technique, donned the sterile gloves, and opened the alcohol pouch, pouring it over the cotton swabs in the kit. She checked the catheter, and then opened the specimen bottle, setting it on the sheet on the stand. Knowing the arrangements that Meghan was already in, Kelsey discarded the drapes.

“Okay, sis. I’m going to clean you off, and insert the cath. It’ll be in and out. Relax as best you can for me.” Kelsey grabbed the tongs for the swabs, picked up a swab, and used her other hand to separate her sister’s labia. She used the 5 swabs once each to clean the vulva, wiping from front to back. She then picked up the catheter, set it at the urethral opening, and advanced it all the way into the bladder. Releasing the labia, she filled the specimen bottle and let the rest of the urine flow into the cath kit tray.

Once urine flow stopped, Kelsey removed the catheter, wiped her sister’s vulva, and removed her gloves. “All done, sis. That wasn’t so bad.”

“Wasn’t so good, either, but I survived. Thanks.” Kelsey took the now-used tray back over towards the cabinets to clean up.

Mitch returned back to his spot between her legs, having changed his gloves. “Okay, now, Meghan, I’m going to insert a speculum to take a look inside. How long has it been since your last PAP smear?”

“Sometime late last year. I’d have to look at my calendar to be sure.”

“Well, it’s almost the end of this year, so we will go ahead and take care of that for you while we’re at it.” Mitch extended a hand to Kelsey, who handed him a medium Graves speculum that had been sitting in warm water. He inserted one finger just into her introitus, applying mild downward tension, and inserted the speculum vertically. Turning it as he inserted it, he opened it partially, located her cervix, and opened the blades fully, turning the screw to lock the blades open.

Adjusting the light again, he looked through the blades at her vaginal walls and her cervix. He accepted the brushes and stick from his wife and collected cervical samples to be sent off for her PAP. Releasing the screw, he closed the blades and withdrew the speculum.

“PAP smear is done, and things are looking good. I’m going to do the bimanual exam now, Meghan. Let me know if anything hurts.” Kelsey applied some lubricant to his fingers, and he brought them to her vaginal entrance. He inserted two fingers and placed the other hand on her lower abdomen. “I’m feeling your cervix… now your uterus... okay, left ovary first.” She could feel his fingers moving inside her, while his other hand pushed down into her stomach.

“Feels fine. Now I’m going to feel the right side. Relax for me as much as you can.” Mitch was a gentle as he could be, but his palpation of her right ovary was almost more than Meghan could take. Mitch removed his fingers from her vagina. “Meghan, your ovary is quite enlarged. I think your pain is possibly due to an ovarian cyst. I can’t confirm that without an ultrasound, but I don’t have one here. We’ll need to get you scheduled for one at the hospital soon.” He removed his gloves as Kelsey handed her some tissues.

“I need to finish your exam, and then we’ll get you settled back in bed,” Mitch told her. She heard new gloves being snapped on, along with the sound of more lubricant being squeezed out. “Relax your bottom, hon. I’m going to do your recto-vaginal exam now.”

“Why?” she asked. Mitch froze. “I’m not complaining. I’ve just never had a doctor do one before.”

Mitch relaxed and brought his gloved hand to her bottom. Slipping one finger into her rectum and two into her vagina, he started feeling around as he answered her. “I do a recto-vaginal exam on all of my patients. It helps me to better examine the posterior of the uterus. I’ve discovered fibroids in a couple of patients that I wouldn’t have found through just the bimanual exam.” He withdrew his fingers, removed the glove, and put on a new glove. Kelsey put on more lubricant.

“Relax your bottom one last time,” he instructed and inserted his finger fully into her rectum. He slowly rotated it 180 degrees in one direction, and then back around the other way, completing a full 360-degree sweep of her rectum. Not feeling anything abnormal, he removed his finger and removed the glove. He stepped out of the way while Kelsey wiped excess lubricant from her sister’s perineum.

“Okay, Meghan, I’m done. I seriously think your pain is being caused by a large ovarian cyst. I’ll try to get you in for that ultrasound before your surgery Tuesday. Based on what that shows, we’ll discuss whether to keep an eye on it or refer you to a gynecological surgeon. I’m sure Kelsey would have a good recommendation there.” Mitch patted Meghan’s arm, then moved down to her legs. Kelsey had already repositioned the drape so the Meghan was covered. Mitch set the bed in motion to bring up the bottom of the bed and helped remove her legs from the supports.

“Are you ready to go back to bed?” Meghan nodded. Mitch picked her up and carried her from the exam room, carefully depositing her back on her bed. “I’m going to leave you alone now. I’ll send Kelsey in when she’s done cleaning up. Oh! And I’ll get her to change out that IV for you. Sorry I’d forgotten it until now.” He turned to leave.

“Dr. Mitch!” He turned back towards her. “I, ah, just wanted to say thanks. You know, for caring for me today.”

He nodded. “You’re always welcome, Meghan. Please don’t hesitate to let us know if you need anything. Goodnight.”

“Good night.” Mitch left the room, leaving Meghan alone with her thoughts. A knock on the doorframe interrupted her. “Hey, Kelsey.”

“Hey, yourself. I have the last bit of nurse stuff to do, and then I’ll just be sis.” Kelsey brought over some supplies. “Let’s change out that IV site. Have a preference as to where I insert the new one?”

Meghan thought for a second and then pointed to a spot on her right arm. “Somewhere up in here would be better. Still a large vein, but not right in my AC space, so bending my arm won’t hurt or interfere with it.”

Kelsey donned gloves and inserted the IV. “Mitch wants a few more labs, what with that cyst, so I’ll get those now.” She drew the bloodwork, then removed the previous IV. “Hold that gauze on there for me while I grab a band-aid.” She finished her ministrations and left the room to deal with the blood samples.

After a few minutes, Kelsey returned, pulling up a chair to Meghan’s bedside. She brushed aside a lock of Meghan’s hair. “It’s been quite the day, kiddo. Are you okay?”

Meghan couldn’t keep the tears from her eyes or the quiver from her voice. “Not really, Kelsey. I’d be happy to wake up and realize today was just a dream.”

Kelsey nodded. “I know you do. It’s been hard here, too. I panicked when Mitch called me and said you’d been hurt. I’m so glad that you weren’t seriously injured.” She hugged her sister, and Meghan hugged her back, hard.

“You know, I don’t even remember the wreck we responded to this morning. But it has been a very overwhelming day.” Meghan blew her nose.

“I’m sure, and I know we didn’t help any with that, which I’m sorry about.”

“Well, I can’t say that I ever expected to be a patient of Mitch’s, that’s to be sure!” Meghan looked at her sister with chagrin.

Kelsey looked at her with a knowing look. “But I’m sure you fantasized about it!” She laughed at her sister’s trapped expression. “I know you’ve always had a crush on Mitch. Heck, for me it was lust at first sight! But he is truly an awesome man, as well as a very knowledgeable and competent doctor. Believe me, this is not how we wanted to show you the remodel.”

“Yeah, trial-by-fire isn’t exactly how I would have wanted to see this for the first time.” Meghan yawned. “I have a question for you, sis.”

Kelsey scooted closer in her chair. “Yeah? What?”

“Remember when we were kids? We’d play doctor on each other, take care of each other when we were sick?”

Kelsey nodded. “Yeah. You loved the sound of the sirens, and I wanted to hold all of the babies.”

Meghan chuckled. “Exactly. And here we are, you a gyn nurse and me a paramedic. But seriously, sis. How hard is it to, well…?”

“To take care of you? To see you be examined, to do procedures on you? Those are the times I have to see you just as another patient, not my sister. I did it because I want you well. You’re my sister and my responsibility. I love you.” Kelsey looked affectionately at Meghan.

Meghan blushed. “Gee, thanks, sis.” She looked indecisive, like she wanted to ask something else but was too hesitant to ask.

“Out with it. I know you want to ask something else.”

“Well… has Mitch ever, well, you know, examined you?”

Kelsey grinned widely. “Actually, he has. Several times. And yes, my butt was the first naked butt on that table. He handles all of my exams now, and I can assure you that his technique is spot-on.” She winked at her sister, who looked embarrassed again.

Kelsey rose. “Well sis, I think we’d best be getting some sleep. Either Mitch or I will be coming in for neuro checks every couple of hours tonight, due to that concussion. If you need anything, and I mean ANYTHING, please press the call button.” She made her way to the door. “Good night, sis. I love you!”

Meghan waved. “I love you too. Get some rest.”

Kelsey left the room after turning out the lights and closing the door most of the way. The hall lights had been turned off, so just light from a nightlight in the hall kept things from being totally dark.

Meghan totally expected that the events of that evening would have kept her awake, but she fell asleep quickly.

**********

Kelsey slipped beneath the covers, trying to not wake Mitch, but he stirred as she climbed in. “Meghan asleep?”

“Yes. I got her settled, drew the labs, and we chatted for a bit.” Kelsey snuggled in close to her husband. “Got an alarm set?”

Mitch gave her a kiss. “Yes. Try for some sleep. I’ll check on Meghan in a couple of hours. Love you.”

“I love you too.”