Dr Farnese was very concerned that I was having some internal bleeding and said I really needed to get a colonoscopy. I told her that I couldn’t, that I had lousy insurance and could not afford it. She considered this and then told me she wanted to see me back for a follow up appointment next week in her office and that this would be in her faculty office across the street rather than the outpatient clinical facility. I asked what the purpose of the visit was, but she was vague in her response only telling me we needed to check this out thoroughly.

The week went by slowly and I could not keep my mind off what she had in mind. Could it be worse than the what I had already been through?

The day of the appointment came and I took the elevator up to the doctor’s office. I told her receptionist who I was and that I had an appointment. She looked at me strangely and pointed me across the hall to an open door. I walked through the door into a small lounge like area with a couch, chairs and bookshelves and a open doorway at the back wall.

Dr Farnese was at her desk in the back room and heard me come in. “Hi Karl. I will be right out.“ She came out into the outer room and closed the outer door to the hallway and we were now in private. As I looked around the room, at first I did not see anything clinical, it just looked like an academic office and I felt a sense of relief, but then in the corner there was a tray with a box of latex exam gloves on it and a fresh plump bulging tube of KY jelly. There was also a plastic dispenser box of baby wipes and several metal instruments in sterile packages that I could not get a good look at, but one riveted me — a thick metal tube about a foot long with a blunt bullet shaped end. I was near panic at this point and did not hear when she told me to sit downtime first time. She repeated more forcefully, “Karl! Go ahead, sit. I want to talk with you about what we will be doing today”

I sat on the couch and she sat facing diagonally from a chair and leaned forward and started in a calm reassuring voice, “I had you come so that I can try to determine the source of you internal bleeding. A colonoscopy would have been best, but I think the problem is low enough in your bowel that I can check it with simpler exam methods. Today’s exam might be a bit more uncomfortable for you, but I will get you through it. I just need you to cooperate and follow my instructions carefully and try to stay relaxed and calm. I was neither at this point and thought about making an excuse to quickly leave, but before I could finish the thought, she got up and told me undress from the waist down. She said she did not have a gown to give me, but that I could leave my hoodie on to stay bit warmer.

She went over to the table with her supplies on it and I pulled off my jeans and then slid off my undepants with a sense of dread. She turned toward me and glanced down at my penis and then motioned me over to the couch. ”Okay, I need you to get up on the couch kneeling and facing away from me.” I awkwardly climbed up onto the couch with my butt towards her. “Now, lean forward and rest your head and your arms on the headrest.“ As I did that, I was more aware of my bottom sticking out toward her, but she instructed me to adjust my position further. “Spread your knees for me and move them forward and push your bottom out towards me.” She guided me gently with her hands which were still ungloved at this point, with her bare hands on my hips as she got me how she wanted me. I felt a need to try to please her and pushed my bottom out as far as I could. ”Good. Stay like that.”

It was hard to imagine a more embarrassing position. I was much more exposed than when she gave me a rectal exam the previous week. The cool air on my anus told me that my knees were far enough apart that my buttocks separated exposing my most private area. My thighs were separated and my penis and scrotum were free in the cool air as well. I could not see her, but could hear her don her exam gloves and she came up behind me and spread out one of those pale blue disposable pads on the couch seat that was beneath me. She then moved a small stool up behind me and sat down. When seated on the stool, my bottom was at the level of her face.

”Okay, first I am going to examine you externally.“ I glanced over my shoulder and say her move a floor lamp behind me. It had a spotlight at the end of a flexible neck. She switched it on and adjusted the beam onto my backside. I could feel the warmth of the light on my skin. When I looked forward again, I saw that the lamp cast a silhouette of the globes of my upturned buttocks onto the wall in front of me. Before the embarrassment of this could sink in, I felt her gloved hands on my buttocks as she gently used her thumbs to spread them a bit wider. “Bear down for me like you are having a bowel movement”. We’re her next instructions. I panicked at the thought of farting and gave feeble push. She was not satisfied, “More. Push harder.“ I took in a breath and pushed out more but still cautiously. ”Good. Keep pushing.” She seemed pleased as my anus bulged and blossomed under her gaze and I felt rewarded by her words of encouragement. She moved her thumbs closer to my opening and this caused my anus to involantarily contract in a wink. “Try to relax, I am just checking outside,” she offered in reasurance. She now moved her fingertips to the outer part of my anus and spread me apart even more and the cool sensation was more apparent when the moist inner part of my anus was opened to the air.

At that moment there was a quiet knock on the door and I jumped and started to get out of position. She firmly put one hand on my back and one on my hip and held me in place, “Stay put, I asked one of my colleagues, a nurse practitioner in gastroenterology to assist me. I am sure that’s her.” She got up to open the door and mercifully opened it just enough to allow the knocker to enter. The introduction was an exercise in mortification —“Karl, this is Diana Jones, she is a nurse practitioner in Pediatric Gastroenterology, she works in the endoscopy unit.”

“Hi Karl, nice to meet you. Looks like things are underway. I know all about your case and I think I can be a help with your exam today.”

I quietly replied, “Nice to meet you. Thanks.”. I craned my neck around to look at her and when our eyes met, she smiled in a somewhat exaggerated way as if she were meeting a child. She had blue scrubs on and though not overweight, the scrubs did not fit her loosely and the shape of her thighs and hips was visible. She had brown hair in a pony tail and a tasteful amount of makeup on. She looked about 30 or so.