Kevin wiped sweaty hands on his pants and rang the Branston’s doorbell. A minute later, Kelsey answered the door. “Morning, Kevin. Come on in!” She smiled as he entered, closing the door behind him. “Right this way!”

As Kelsey led him back towards the exam room, Kevin noticed she was wearing scrubs. Reaching the room, Kelsey gestured him in and led him to the scale. “Let’s get your weight, Kevin.”

Kevin climbed up on the scale, waiting while it registered his weight. Kelsey recorded it on a chart she carried and gestured to the exam table. “Hop on up, and let’s get your vital signs.”

As he complied, Kevin asked, “Do you often help Mitch with his home office?”

Kelsey smiled and nodded as she brought over a blood pressure cuff and finger pulse oximeter. “When I can, I do. And yes, I’ll be assisting him today with your exam and enema session.” She wrapped the cuff around his arm and placed the probe on his finger. She inflated the cuff and listened to his blood pressure with her stethoscope. “A bit high, but then again I’m sure you’re nervous.” She smiled reassuringly, removing the equipment and writing the numbers down on his chart. Pulling on a pair of gloves and picking up the thermometer and a tube of lube, she turned back to Kevin. “Okay. Pants down and onto your stomach, please.”

Kevin stared at her, wide-eyed. “What?!”

“Dr. Meyers, we only take rectal temperatures in this clinic. As you know, it is the most accurate way to get a temperature. So, pants down and onto your stomach, please.” Kelsey was polite, but her tone was definitely no-nonsense. Kevin reluctantly stood, undid his pants, and, dropping his pants and underwear to mid-thigh, lay down on the exam table, bare bottom up.

Kelsey placed a small amount of lube onto the thermometer sheath and another bit onto her index finger. “You’ll feel me touching you,” she warned before separating his buttocks and bring her lubed finger to rest against his anus. He jumped a bit as the cool lube came in contact with his anus, but did his best to relax as she gently inserted her finger, lubricated his rectum, and replaced her finger with the thermometer probe. The minute it took for the machine to register his temperature seemed to last forever, and he was relieved when she pulled the probe from his anus. “Looks normal. You can pull up your pants and have a seat.”

He quickly returned his clothing to their normal position while Kelsey recorded his temperature and disposed of the equipment. She rummaged in cabinets for a moment before returning to his side. “Okay, doctor, you know the drill. Everything off, including socks and underwear. The gown can go with the opening in the back. Here’s a drape for your lap. Once Mitch has completed your physical, we’ll draw labwork. You’ll probably also want to void your bladder. You can change in the bathroom, which is right through that door there. When you’re changed, just sit back on the exam table. Mitch and I will be back in a few minutes.” With one final encouraging smile, Kelsey left the room.

Kevin started at the gown for a minute, but headed for the bathroom. He relieved himself, got undressed, and put on the gown. Clutching the gown behind him, he sat down on the exam table and opened the drape somewhat, positioning it over his lap. He glanced at the cabinets, looking for any hint as to what was coming up, but aside from a stethoscope and tube of lubricant, there wasn’t really any hint of what would be happening.

A knock sounded at the door, and Mitch and Kelsey came into the room, closing the door behind them. Mitch had the chart in his hand as he approached Kevin and shook his hand. “Good morning, Kevin. Ready to do this?”

Kevin gave a quick laugh. “I guess so. Kind of a stark reminder as to what my patients go through.”

Mitch nodded. “It’s never easy to be the patient, but this is just a physical. No surgeries or anything.”

Kevin nodded. Kelsey handed Mitch his stethoscope, accepting the chart from him.

“Okay, let’s get started. I’m going to listen to your lungs. Lean forward a bit.” Mitch listened to Kevin’s lungs in several places. “Good and clear.” He wrapped the stethoscope around his neck and accepted the otoscope from Kelsey. He checked Kevin’s pupils, ears, nose, and throat. Handing the otoscope back to Kelsey, he palpated Kevin’s lymph nodes and thyroid.

“Kevin, I need you to remove your arms from the gown sleeves and let it drop into your lap.” Kevin complied. Mitch put his stethoscope back in his ears and listened carefully to Kevin’s heart before putting the scope back around his neck. “Kevin, I’m going to do a breast exam. Even us guys can develop breast cancer, as you know.” Kevin nodded. It felt weird having Mitch go through most of the same exam that he frequently gave his patients, but he knew Mitch was right. Male breast cancer is a lot more common than most people realize, and it often isn’t caught until late.

“Everything seems good,” Mitch said encouragingly. “You can put the gown back on.” He waited until Kevin had gotten the gown back on. “Okay, I’m going to lower the back of the table. It’s electric.” He set the table in motion until it was flat. “Lay back for me, Kevin.”

Kevin lay down so he was flat on the bed. Mitch pulled out the table extension for Kevin’s legs. “I’m going to move to the abdominal exam now.” Mitch adjusted the drape so it was just above Kevin’s pubic region and pulled the gown up to just under his rib cage. Mitch listened to bowel sounds and slipped the bell under the drape to listen to the femoral arteries. Slinging the stethoscope over his neck again, Mitch placed sure fingers on Kevin’s abdomen and started palpating. “Any pain or tender areas?”

Kevin shook his head.

Mitch lowered the gown and pulled up the drape a bit. He then moved to check Kevin’s feet and the pulses there, checking for signs of edema or injury. “Any issues with shoulders, knees, hips…”

“No, my joints are behaving, aside from the inevitable backache and sore feet that come with a long shift or surgery rotation.” Kevin chuckled.

Mitch pushed in the table extension and gave Kevin a hand up to sitting. “You’re preaching to the choir on that one, I’m afraid. And it gets worse the older you get.” He smiled.

“Everything is looking good so far, Kevin. It’s time to move on to the genital portion of your exam. If you would, go ahead and stand up here at the end of the table.” Kevin nodded and got up off the exam table while Mitch retrieved the Mayo stand Kelsey had prepped for him. He pulled on a pair of the gloves she had set out and settled on his rolling stool, moving to sit right in front of Kevin.

“Please lift the front of the gown. Or you can take it off, your choice.” Kevin thought for a moment, and just removed the gown, setting it with the drape on the exam table. Mitch took a moment to do a visual inspection before reaching to grasp Kevin’s penis, palpating and inspecting the shaft and meatus. He took a quick peek at the urethral meatus, separating it briefly. Kevin, familiar with the exam, held his penis out of the way as Mitch moved to inspect and palpate his scrotum and testicles. Mitch then inserted a finger into each inguinal canal in turn, checking for hernias.

“Everything’s checking out okay, Kevin. Let’s go ahead and do an initial DRE. If you’ll bend over the exam table, legs spread and toes pointing towards each other…” Kevin assumed the position, his chest resting on the table. Mitch squirted some lube on his finger. With a word of warning, he separated Kevin’s buttocks, inspected his anus, and brought his finger to Kevin’s anus. “Relax against my finger.” As he felt Kevin relax, Mitch inserted his finger fully. He gave Kevin a moment to adjust before doing a complete 360-degree sweep of the rectum. Mitch then palpated Kevin’s prostate, taking care to thoroughly examine the walnut-shaped organ. Mitch removed his finger, wiping it on a guaiac card, which Kelsey took and tested – negative for blood.

“Okay, Kevin, you can take a seat back on the exam table and cover up.” Mitch stripped off his gloves and disposed of them as Kevin sat back down on the table, opting to just put the drape back over his lap. Mitch returned to his rolling stool and sat down. “Well, Kevin, I’m not finding anything abnormal with your exam. I want to do some labwork, but otherwise I’d say you’re in great health.” He smiled.

Kevin also smiled. “That’s a relief! I’ve not had any health concerns, but there’s always that small worry during an exam.”

Mitch nodded. “I’m going to jot some notes on your chart while Kelsey draws blood and gets a sterile urine sample. Then we’ll switch gears and set up for those enemas. You felt rather full when I did the DRE. How long has it been since you had a bowel movement?”

Kevin nodded, feeling nervous again. “It’s been a few days, not that that is abnormal for me.”

Mitch nodded again. “I suspected that.”

Kelsey came over with a Mayo tray with blood tubes, a vacutainer, gauze, tape, a tourniquet… and a catheter kit. Kevin’s eyes grew wide, but Kelsey was already in nurse mode and not going to take no for an answer. “Lay down for me, Kevin. We’ll do the blood draw first, and then get that urine sample.”

Kevin sighed, but complied, holding out his left arm for her.

Kelsey quickly drew the blood work, filling the tubes and placing labels on the tubes so they would be ready to take to the lab. She cleared the trash off of the Mayo stand before starting to set up for the sterile catheterization. “Okay, Kevin, I’m going to remove the drape for a few minutes. It’s an in-and-out catheter, so this won’t take long.” She opened up the catheter kit, making sure to keep everything sterile. She donned the sterile gloves, draped him accordingly, and grasped his penis firmly before cleaning the meatus carefully with the alcohol swabs. She inserted a syringe filled with lubricant into the head of his penis, injecting the lube into his urethra. “Okay, Kevin, here we go. Deep breath in, and out.” As he exhaled, she slid the catheter into his urethra and threaded it up into his bladder. When urine started flowing, she filled a specimen jar partway, and let the rest drain into the catheter kit. Once flow stopped, she instructed him to take a deep breath again and removed the catheter.

Kelsey smiled at Kevin and began cleaning up, covering him with the drape again. “See? You lived.”

Mitch came over once Kelsey had finished. “Ready to start the enema series?”

Kevin sighed and nodded. “Yeah, I think so.”

Mitch smiled reassuringly. “Give me a few minutes to get everything ready.” At Kevin’s nod, Mitch moved away to the enema equipment Kelsey had already set out. He filled the bag with warm water and soap and attached a nozzle. Kelsey had stocked a Mayo stand with gloves, lubricant, and the thermometer, so he maneuvered the stand and an IV pole containing the enema bag up by the exam table. Mitch then extended the stirrups on the exam table. “Kevin, I’m going to have you in the stirrups for this first enema. It will allow easy access to your anus and make it easier to help you with the cramps and such.” Mitch helped guide Kevin’s feet into the stirrups, pushed in the table extension, and then guided Kevin towards the edge of the table. “Good! Right there.”

Mitch gloved up and lubricated his finger. “I’m going to go through the steps that I normally take in an enema series from the beginning.” He raised the drape so it rested on Kevin’s abdomen, exposing his genitalia. Mitch adjusted the nearby exam light so he had adequate illumination. He separated Kevin’s buttocks with one hand and brought his lubed finger to Kevin’s anus. “Bear down for me, please.” He slipped the lubed finger into Kevin’s rectum and performed a careful DRE. As he brought his finger out, he felt a spot close to the outer anal sphincter. He moved his finger back in a bit and palpated more thoroughly before removing his finger and regloving that hand.

Kevin noticed the change in the exam and grew concerned. “What is it, Mitch?”

“Nothing serious, but I think you might have a hemorrhoid there. I’ll take a closer look after we do your enemas, just to be sure.” Mitch put some lubricant on the thermometer and inserted it. “A quick rectal temp,” he explained. Once the temperature was done, he removed the probe. “99.8, which is normal for a rectal temp.” Setting the thermometer aside, he reached for the nozzle and applied a generous coating of lubricant.

“Okay, Kevin. I’m going to insert the enema nozzle now. Relax for me.” Mitch brought the nozzle to Kevin’s anus and slowly inserted it until it was seated in Kevin’s rectum. “And here’s the water. I’m going to keep the flow slow, but if you need me to pause it, let me know. And I’ll be massaging your abdomen to help with cramping.” With that, Mitch opened the clamp, adjusting the flow rate to be rather slow.

Kevin was surprised by the size of the nozzle, which felt huge in his rectum, but his mind was quickly taken from that thought when the water started flowing. He thought it actually felt rather good… until the first cramp hit. “Ooh, ow!”

Mitch was prepared. He reached under the drape, placing a gloved hand on Kevin’s abdomen, and started massaging in a counter-clockwise motion. “Breathe through it, Kevin. It’ll go away in just a bit.”

As the water continued to flow in, Mitch helped Kevin through several cramping episodes. Finally, the bag was empty. Mitch clamped the tubing. “Good news, Kevin: all of the water is in now. I want you to hold this for 10 minutes before I send you to expel. I’ll keep up the massage to help with any cramping. Kelsey, would you set the timer, please?”

Although it seemed much longer to Kevin, the 10 minutes passed quickly. Mitch removed the nozzle from Kevin’s anus, helped him down from the stirrups and the table, and sent him hurrying to the bathroom.

Mitch and Kelsey cleaned up from the first enema. Mitch pushed the stirrups back into their spot on the exam table, wiped the table down, and pulled fresh paper over it. He then rinsed out the enema bag and tubing to get all of the residual soap out of them before filling the bag up with nice, warm water. He removed the nozzle and replaced it with a colon tube. Kelsey had already made sure there were fresh gloves and lubricant on the Mayo stand.

Mitch glanced over at Kelsey. “Hon, why don’t you get an anoscope prepped for after this second enema? I think he has a hemorrhoid, but I want to double-check it before he leaves.”

Kelsey nodded. “Do you want clear plastic or metal?”

“Let’s go with the clear plastic. It felt like it was just inside the anal sphincter.” Kelsey started rummaging in the cabinets just as Kevin emerged from the bathroom, drape wrapped protectively around his waist.

“How are you feeling?” Mitch asked.

Kevin gave a sigh as he approached and sat down on the exam table. “That was very intense, but very effective! I didn’t think I had that much fecal material inside me!”

Mitch nodded knowingly. “Yeah, you’d be surprised. Especially when a lot more comes out with this second, rinse enema.”

Kevin shook his head. “I’m assuming that I’m going to be in a different position since you put up the stirrups.”

Mitch nodded. “I want you in knee-chest position for this one. I’m also going to use the colon tube this time.”

Kevin got up and climbed up onto the exam table, getting into the requested position, keeping himself close to the end of the table. “Good, Kevin,” Mitch said. Mitch gloved up and put lubricant on an index finger. “I’m going to do another quick DRE to see how well that first enema did and to lubricate you again.” Mitch brought his finger to Kevin’s anus and inserted it, being sure to spread lube all around. He removed his finger, stripped off the glove, and put a clean one on. He lubricated the first 3 inches of the tubing and brought it to Kevin’s anus. “Okay, Kevin. I’m going to insert the tube a bit, then start the water. The water will help me insert it fully up into your colon. You shouldn’t have many cramps this go-around, but you might feel the tube as it works up into your colon.” Mitch inserted the tube about 4 inches and started the flow of the water, setting the flow rate higher than the first time. He slowly inched the tube into Kevin’s rectum until all 30 inches were seated in Kevin’s colon. “The tube is completely in, Kevin, and you’ve taken about half the bag so far.”

Kevin just grunted in reply. This was much easier than the first enema, but he was also well aware of how completely exposed he was in this position. He was very thankful when Mitch pulled the drape over him during the 10-minute hold time. Finally, he felt Mitch moving the drape enough to slip the colon tube out of him and send him on his way back to the bathroom.

When Kevin returned the second time, he saw the chair had been reconfigured again, this time in a more typical proctology arrangement.

“Kevin, how are you feeling?” Mitch greeted him.

“You were right – had a lot more fecal material come out. But I’m feeling pretty good, actually.”

“Good! Listen – I want to check that spot I felt in your rectum before we finish up for the day.” Kevin was ready to be done, but he nodded. Might as well get it checked out now instead of having to make an appointment with someone else to check it later! Kevin positioned himself on the chair, kneeling on the knee supports and draping himself over the end of the exam chair. Mitch set the chair in motion, raising it up and tipping the chair forward so that Kevin was jackknifed in position. Mitch donned gloves, applied lube to his finger, and brought it again to Kevin’s anus, slipping the digit inside. He felt around again inside Kevin’s anal sphincters, finding the spot he had felt earlier. “Kelsey…”

Kelsey brought over the anoscope, handing it to her husband. “Kevin, I’m going to insert an anoscope so I can visualize that spot. It’ll feel a little bigger than my finger.” Mitch removed his finger and inserted the anoscope. He removed the obturator and repositioned the exam light to give him a good view. The tissue of Kevin’s anus and rectum looked nice and healthy. Mitch was able to visualize the spot he had felt in Kevin’s anus. He slowly removed the anoscope and used the wipes Kelsey handed him to remove excess lubricant from Kevin’s anal area. He then put the table back into motion, making it easier for Kevin to get up.

“Okay, Kevin, we’re all done! Why don’t you get dressed, and then join me in my office?” Mitch stripped off his gloves and tossed them in the trash.

Kevin nodded and headed for the bathroom again. He took the time to wipe off thoroughly before getting dressed again. It felt good to be back in his own clothes! He returned to the exam room with the drape. Kelsey glanced over at him and smiled. “You can just leave that on the exam table, Kevin. Mitch is in his office. Head out that door and it’ll be the first door on your left.”

Kevin joined Mitch in the office, settling in the same chair he had occupied the evening before. “Well, Mitch, am I gonna live?” he joked.

Mitch chuckled. “Yes, I think you’re going to be around for a while.” He pulled up his notes and the chart they had been keeping. “Of course, we’ll need to wait a few days to get your lab work back, but really the only thing I found on your exam is a hemorrhoid. It’s not big, but it is just inside the internal anal sphincter. You can leave it alone, or you can find someone to take care of it for you.”

“It hasn’t bothered me,” Kevin replied. “I didn’t know it was there until this morning.”

Mitch nodded and settled back in his chair. “So… what did you think about the enemas?”

Kevin thought about it a moment. “It didn’t feel like I thought it would, which isn’t a bad thing. The cramps were intense, but those were with the first one, the soapy one. The second enema was much easier in comparison. Do you ever have… sensual… feelings when you do enemas?”

Mitch nodded. “One of the joys of having a prostate.” He smiled.

“I wondered,” Kevin said. “I could see how a man could potentially enjoy enemas, given he could relax enough into it.”

Mitch nodded. “Yes, sometimes they are nice for that aspect. Of course, they are also well-appreciated for the cleansing effects, particularly with bad constipation issues.”

Kevin’s stomach took that moment to rumble loudly. “Well, Mitch, I think I’d better go feed this stomach of mine. Thank you for this morning.” He stood, and Mitch followed suit, holding out his hand and shaking Kevin’s.

“You’re welcome. I’ll let you know when we get those test results back. And if you have any questions or concerns, feel free to give me a call.” Mitch escorted Kevin out and made his way back to the exam room.