Fifteen minutes later, Meghan was starting to feel better. Mitch had inserted the IV, and saline was now dripping through the tubing into her body. More morphine was on board, as well as another dose of Zofran. She sighed and snuggled under the warm blankets Kevin had draped over her body after helping her out of the stirrups.

Mitch came back to stand next to her. “How are you feeling now? Pain scale?”

Meghan gave him a small smile. “Much better, and two.”

“I’m glad,” he replied. “Think you’re ready to start the enemas now?”

Her smile disappeared, but she nodded. “Yes, I guess so. I just want to be done with the whole thing.”

He patted her shoulder reassuringly. “I know, kiddo. Why don’t you roll over onto your left side, and bring your right knee towards your chest? I’m going to go get the thermometer and some lube.”

He watched as she shifted under the blankets into position and pulled a pair of gloves out of the box on the wall. He put them on, grabbed up the tube of lubricant and the thermometer, and returned to her side, standing behind her. He set the items down on the stand Kelsey pulled up for him and reached for the blanket over Meghan’s hip. “I’m going to uncover you now,” he warned, as he pulled up the blanket and then lifted her gown from over her bottom. “Bring your leg up a little higher,” he instructed, “yes, just like that. Good.”

He popped the cap of the tube of lube and squirted some onto a gauze pad. He dipped the thermometer probe into the lube, and then his right index finger. “You’ll feel me touching you.” He used his left hand to separate her buttocks and brought his finger to her anus. “Relax, Meghan.” He waited to feel her sphincter relax and inserted his finger. He performed a careful DRE, being sure to lubricate all areas of her rectum.

“Finger out, thermometer in,” he said, removing his finger and inserting the thermometer deep into her rectum. He waited for it to register, and removed it after it beeped. “99.7: good to go!” He lowered the drape over her, removed his gloves, and carried the thermometer over to the counter, disposing of the probe cover and his gloves.

Kevin joined him, having watched from behind him. “So you start with a digital exam and then do a temperature?”

Mitch started assembling the nozzle to the bag, squirting in some soap and turning the water on, adjusting the temperature. He started filling the bag with water. “Yes, that is how I do it. I can check for any impactions, which might adjust how I administer the enema and also lubricate the rectum. And the temperature is for vital signs.” The bag filled, he turned off the water and hung the bag on the IV pole on the hook opposite Meghan’s IV bag.

He moved to stand in front of Meghan. “Okay, I’m ready to start your first enema. I’ll be having you shift around during it so we can get it up as high as possible. I’ll tell you when I need you to shift and how. Any last-minute questions?”

Meghan shook her head. “Uh, Dr. Mitch? Is it too late to request the music?”

He smiled. “Absolutely not. I have a spa music channel I can pull up if you want, or I can find something else.”

“Spa music will be fine. I think I want something relaxing to help me through this.”

Kelsey stood from the chair she’d been sitting on. “I’ve got it, Mitch. Go ahead and get started.”

He nodded, and she left the room. Mitch moved back around the table to Meghan’s backside, pushing his wheeled stool with him, and then came back to move the IV pole to her back. He pulled on more gloves and motioned for Kevin to join him. He lubed up the nozzle in the lubricant on the gauze from earlier and again lubricated a finger.

“I’m going to uncover you now,” he said, lifting the blanket and the hem of the hospital gown to expose her buttocks again. “Touching,” as he separated her buttocks, “and relax for me. Deep breath in and out.” He inserted his finger deeply to do one final lubricating effort, then removed the digit. He picked up the nozzle and brought it to her anus. “And now the enema nozzle. Deep breath, Meghan.” He gently inserted the nozzle until it rested in her fully.

“You’re doing great. I’m going to start the water now.” He saw her nod as he reached and opened the clamp, adjusting the flow. “Let me know if you start cramping.” He stripped off his gloves and reached over her side to rest his right hand on her abdomen and started gently massaging, helping the water to get deeper into her colon.

When the bag was about a third of the way empty, he stopped the flow. Meghan had had a couple of cramps, and he had helped her through them. “A third of the way through, Meghan. I want you to lie flat on your back now. Let’s get that water in higher.” He assisted her in rolling over and guided her right leg, positioning it with her foot on the table extension, her knee in the air. He checked the tube placement and started the flow again. He brought his hand back to her abdomen and resumed massaging her tummy. Cramping happened a few more times but was manageable.

She had taken two-thirds of the bag when Mitch stopped the flow again. “You’re doing great, Meghan. I want you to roll over to your right side this time. Let’s get the rest of this bag to clean out as far in as we can get.” She rolled over to her right side, now facing him. He smiled at her. “You’re doing great. Just a little more to go.” Reaching over to unclamp the tubing, he let the flow speed up some. The bag was soon drained, and he clamped it off.

“It’s all in, Meghan. I want you to try to hold it for 10 minutes. Kevin, could you set the timer on the counter, please?” Kevin went and did as he was asked. The sound of ticking could be heard faintly over the relaxing music playing in the room. Mitch looked at Meghan. “You can either continue to be on your right side, or you can go back to your back, whichever you prefer.”

She thought for a minute and rolled back to her back. Mitch dropped the blankets back over her but pushed them up from the bottom so that he could continue to massage her stomach. The cramps were coming in waves, and he could tell that she was uncomfortable. “Do you want a little extra help?” he asked, delicately.

Meghan was thankful that Mitch asked as he did. While a part of her did want the added distraction from the cramps, she definitely didn’t want him to touch her in a sexual way in front of someone other than Kelsey. “No, I’ll be okay,” she gritted out as another cramp hit.

It was a rough 10 minutes before the timer went off, but Meghan had managed. Mitch lowered the chair, removed the nozzle, and handed her the crutches and she was off to the bathroom. Kevin watched as the door closed behind her. “So now she will expel the enema solution?”

Mitch nodded as he cleaned up the equipment in preparation for the second bag. “Yes. It might take her 20 minutes, as the water and stool come out in waves. The next ones are all just tap water, so they will be easier on her system than the soap is.”

Kevin pondered the process and asked some more questions, which Mitch was happy to answer. And it was almost 20 minutes when Meghan opened the door and came out.

“How are you feeling?” Mitch asked as she approached the exam chair again.

“I’m okay. That was a little easier to go through than the last time.” She sat on the chair and handed him her crutches. Setting them aside, Mitch helped her cover back up with the blankets and drape. “Well, the next one will be a rinse, so no soap. Go ahead and lie down on your left side again, just like you did before.” She lay down and got into position while Mitch filled the bag with warm water. He brought it to the IV pole, hung it, and reached for gloves.

Warning her, he exposed her bottom and reached for the nozzle, swirling it well in lubricant. He parted her buttocks and brought the nozzle to her anus. “Okay, relax for me, Meghan.” He inserted the nozzle fully and opened the bag. “Just like before, I’ll be stopping this a couple of times so you can change positions.”

It was obvious that this enema was easier on Meghan: it flowed in easier, and she had a lot fewer cramps. He had her shift positions after the first third and then again after the second third of the bag had gone in. Once the bag drained, he clamped it and helped her back onto her back. “Another 10-minute hold for this one.” Once the hold time had lapsed, Mitch removed the nozzle and sent Meghan to the bathroom.

Kevin assisted this time with the cleanup. “That one seemed to be easier on her than the soapy one.”

Mitch nodded. “Soapy enemas aren’t the easiest, but they do a much better job of cleaning out the colon and stimulating peristalsis. The second one acts as a rinse, helping to remove more fecal matter and rinsing any lingering soap out of the system.”

“So a normal enema series would consist of one soapy enema and one rinse?”

“Yes. However, we want to be sure that the colon is empty, so now it’s a matter of making sure it is. People generally refer to this as ‘enemas until clear’ – we want everything coming out to only be the water going in.”

Kevin thought for a moment. “Isn’t it difficult to make sure that your water or solution is rounding all of the bends in the colon?”

Mitch smiled. “It can be, but we have a good way to get the water in as deep as we need it to go.” He reached over and picked up a rubber tube. “This helps us get the water where we need it to go. It’s commonly referred to as a colon tube or colon snake. I’ll feed this up into Meghan’s rectum just like you do with a flexible sigmoidoscope and administer the enema high in her bowels. This will flush the ascending colon and then backfill the rest of the colon. It’s actually about the most comfortable of the enemas, but you do have to get the colon somewhat clear before inserting it due to maneuverability in the intestine.” He set the tube back down.

Kelsey, who had been sitting next to her sister during the enemas, stood and stretched. “It’s a whole different world than the standard Fleets we administer in-hospital,” she remarked. “It’s amazing what nurses used to do, compared to the ‘time-saving’ of laxatives that don’t work. Having been married to Mitch and learning about this makes me wish we would go back to the older bowel routines with some of our patients.”

Meghan reappeared and approached the exam chair again, standing beside it. Mitch came over to her and draped a fresh blanket over her, having just pulled it out of the warmer. “How are you doing? What’s your pain level?” She handed him her IV bag, which he re-hung on the pole.

“Okay, I guess. My butt’s getting a little sore, but otherwise, I’m at a 3.” She looked at the chair and sighed.

“You’re doing well, Meghan. Depending on how this enema comes out, this might be your last one. Otherwise, we’ll stop at four. Why don’t you stand here for a moment? I need to put the leg supports on the chair.” She nodded, and stood, watching, as Mitch inserted the leg supports into their respective holders, the metal of the pipes clanking against the table as they were fitted and positioned.

Mitch patted the chair. “Okay, Meghan, have a seat.” She sat, and he set her crutches aside. “I’m going to put you back into the leg supports for this round. I’ll be inserting a colon tube, and will work it up high into your colon, so the water can really get in the ascending colon. You won’t have to hold this enema, but I’ll need you to tell me if you’re still getting fecal material out when you expel.” Meghan nodded.

Mitch helped her to lie back and get her legs situated in the supports. He dropped the end of the table, leaving her buttocks hanging at the edge. He shifted the drape so that she was mostly covered but still giving him access to her anus. Now having Meghan in position, Mitch filled the bag again, attached the colon tube, and brought everything over to where she waited. He lubed the tube generously and brought it to her bottom. “Relax for me, Meghan. I’m going to insert the tube a little way, and then start the enema. The flow will help me advance it further in.”

He inserted the tube and started the water. He inserted more and more of the tube, going higher and higher into her colon until he had three-fourths of the tube inserted. “Doing okay?” he asked.

“Yes. It felt kinda weird as you were inserting the tube, but I feel okay.”

He smiled. “One of the nice things about the colon tube is that cramps are pretty rare.”

“Works for me,” she said.

Kevin looked at Mitch from his seat behind him. “How did you start learning about enemas, Mitch? Was it taught when you were in med school?”

Mitch laughed. “No, my education regarding enemas came from when I was growing up. My brother and I received them regularly from my mom and grandmothers. We got them when we were sick, when our systems got sluggish, and sometimes just because. It’s definitely effective to take care of constipation, and also for bowel preps like we’re doing here with Meghan.” The bag flattened, signaling all the water had gone in, so Mitch closed the clamp. “Okay, Meghan, this one is done. Let me raise up the end of the bed.” He put the chair in motion, bringing up the end of the chair under her bottom. He helped her out of the stirrups and Kevin unhung her IV bag, holding her crutches at the ready. Mitch reached behind her and pulled out the tubing. Meghan grabbed her IV and crutches and once again made a beeline for the bathroom.

When she returned again, everything had been cleaned up. “What’s the verdict, Meghan?” Mitch asked.

“Clear,” she responded, “thankfully. My butt hurts.” Mitch smiled and patted the exam chair once again.

“Come over and lie down one more time, on your left side. I’ve got some ointment that I can put on to help.” She sighed but lay down again. Mitch retrieved a tube of ointment and a glove. He placed a good bit on his gloved finger and rubbed it around her anus, then inserted his finger just inside the sphincter, rubbing the ointment around as thoroughly as he could. He removed his finger and helped her sit up. “There you go. It has some lidocaine in it, which should help to numb up those irritated nerves.” He removed his gloves and disposed of them. “Now, the only thing you can have between now and midnight is water. We don’t want to undo what we just put you through!”

She sighed and nodded. “That’s for sure!”

Mitch smiled. “Here, let me remove the fluids from your IV, and I’ll let you go change. I have just a bit of cleanup here to do, and then we’ll be in the living room.” Meghan nodded and headed through the bathroom to her room as soon as Mitch had removed the IV bag and tubing.

As Mitch cleaned, he looked at Kevin. “So what do you think? Was it what you expected?”

Kevin shook his head no. “Not really what I expected, to be sure, although I’m not sure what I expected if that makes sense. It does seem like it is a gentler methodology than the pharmacological approach, but possibly could take longer.” He seemed introspective for a moment. “I’m curious to try it for myself sometime.”

Mitch gave him an appraising look. “If you ever decide to and need assistance…”

Kevin just nodded. Kelsey came over. “I’m going to head for the living room. Kevin, care to join me?”

He shook his head. “I’d probably better get going. I need to get some sleep so I’ll be good to go for Meghan’s surgery in the morning. Please let her know I appreciated her letting me observe.”

“I’ll do that, Kevin. Let me show you out.” Kelsey led the way out of the exam suite and down the hall. “Thank you again for bringing over all of the goodies. I’ll get Meghan to help me go through them tonight. We'll see you in the morning.” He gave her a hug and left.