Alan knocked rather timidly on Sarah’s door, perhaps hoping she wouldn‘t answer. No such luck. He still had his fist in the air when she swung open the door. She looked at him and after a few seconds, smiled, nodded him in, “Come in, my new patient!”

Alan dropped his chin down and strode by her into the main room of her suite. As a resident advisor, Sarah had no room mates, so she had her own bedroom, a common area, a bathroom and an extra bedroom she used mostly to study and store some things. Allen noticed how neat and clean everything looked and that it had a subtle pleasant smell of perhaps shampoo or or perfumed soap rather than the locker room and stale beer aroma of his own suite.

Sarah brought him into the spare room she studied in and moved some of her books off the narrow twin bed and told Alan to sit down on it. She asked him if he wanted something to drink and he said yes, trying to be agreeable. She was very pleasant and when she wasn’t smiling at him, she had a hea- tilted-to-the-side look of maternal concern on her face. If seemed to Alan that at any moment she might reach out her hand to his forehead to see if he was feverish.

She poured him some iced herbal tea and handed it to him. When he skeptically smelled it and sipped it, she informed him, “Its GOOD for you. Like a new beginning. Just drink it.“

Sarah pulled up a chair and sat facing Alan a few feet in front of him, but she was about a half a foot higher up, so she was looking down at him. The bed he was sitting on was so low, his knees were up higher than the level of his navel.

She took out an iPad and told Alan she was going to take his medical history. He was elusive and did not volunteer any information that might embarrass him, though he could tell by her line of questioning that she was trying to extricate that very information. She let this pass but then when she began taking his review of systems, she was more blunt, “Any trouble peeing or pooping?”

Alan sat slack jawed and silent. He knew the topic was coming of course. It was the whole crux of why he was there, but he tried to make believe that he could avoid it.

The silence caused Sarah to look up from her tablet and look at him in the eye. “Well?”

”Um, well, yeah, some trouble.”

”What sort of trouble?”

”Um, I’m, I’m having trouble going…”

”Are you constipated?”

Alan was looking down and wouldn’t answer.

Sarah got up and came over and sat down next to him. She was turned to him and asked again, “Alan, are you constipated?”

”Yes.” Alan said this without looking at her, but was aware she was closer than she had ever been to him, close enough he could smell the sweet cinnamon and clove aroma of her hair. He had noticed it before when she was in the elevator with him and now it was finally fully there in his nostrils.

”I knew that of course, but I needed to have you say it out loud to me. I need you to be very honest with me, to trust me and cooperate with me with what I might ask you to do. Will you do that for me?”

Alan knew what he was going to answer, but paused as he processed this. He thought about how he could bolt from Sarah’s room. Then he contemplated his predicament. He became physically aware of his hangover queasiness, his sore bottom and the rollercoaster of freshman year loneliness. He sensed that there would be relief from these torments in what Sarah was offering. He felt himself ready to submit and surrender to her, but knew that the embarrassment he felt right then would likely be nothing compared to what might come with the bargain.

“Okay.” He finally answered. “But I don’t want my mother to be snooping into this. I‘m going to cancel her access to my record.”

”Okay, you have my word I will not share medical information with her provided you are honest and cooperative with me. Is that a deal?”

”Yeah, fine. Deal.” Alan replied as he was still looking down as the implications of this raced through his mind.

”And as part of the deal, you will also keep quiet about my medical advice and help as well, ok?”

”Why would I tell anyone about this?” Alan asked as he looked up at Sarah puzzled at her request.

”You might find you are so pleased with my advice and care that you want to share your experience,” she said with a bit of playfulness in her voice.

”Um, no, that is not going to happen.” Alan replied still puzzled.

”That you won’t be pleased or that you won’t want to share it?”

”That I won’t share it …ever!”

Alan thought it very odd that he would have to state the obvious, but Sarah realized she was a bit on thin ice. She was, after all, unlicensed and not even a nurse yet. She was confident in her abilities and indeed at the top of her class and her summer experience working as a medical assistant made her quite confident as well, but she realized she could be in trouble if it was found she was passing herself off as a medical professional when that was not actually the case. She regretted requesting confidentiality from Alan as she thought it might arouse some suspicion and she did not want him to become aware of this potential source of leverage in their dynamic.

Sarah got up and started clearing the textbooks and the few boxes of her belongings around Alan on the bed. “Okay, I want to examine your belly, so lay down on you back.”

Alan just sat and and watched her remove the last of her books. She looked at him with a bit of impatience and that was enough to spur him. He swiveled around and stretched out flat on his back.

Sarah got a pillow for him to rest his head on and then reached for the sides of his T shirt, “Lift up so I can raise this.”

Alan lifted as she asked and watched his bare belly come into view. Before he lowered his weight back down, she grabbed the elastic band of his gym shorts at his hips and wriggled them down a few inches startling him and causing him to tense and start to sit up.

”Relax,” Sarah said as she eased him back down with her hands.

He looked down anxiously at how much he was exposed and saw his lower abdomen with a narrow trail of hair that broadened to just a hint of his pubic hair at the top of his lowered waistband. Not awful, but awkwardly embarrassing enough.

Sarah reached to the table above Alan’s head and retrieved her sTethoscope.

Alan recognized the shiny blue coils that he had seen so often poking out of her bag in the elevator. She started to warm the bell and diaphragm with her hands. She then gently put the diaphragm against his pale abdomen and silently listened, moving it around from quadrant to quadrant. He could not imagine the nurse practitioner at the student health center bothering to warm it up. He felt himself calming down a bit.

Sarah finished with her auscultation and put her stethoscope aside. She put her hands gently on Alan’s skin, starting up near the edge of his rib cage. He flinched a little.

“Relax, slow deep breaths through your mouth.” Sarah said softly.

Alan did as he was told and found himself relaxing in spite of himself. This was the first real physical human contact her had had in more than two months he realized how he had been longing for it without knowing it. Sarah’s hands were warm and soft and moved so confidently over him and he found it pleasant even when she started to push more firmly.

Sarah‘s hands made their way downward and Alan tried to stay calm, but flinched a bit as here fingers venture slightly under his waist band. It was also a bit physically uncomfortable there.

Sarah told him to relax again, “I need focus down here. CLose your eyes and concentrate on your breathing.”

She pressed more firmly and when Alan opened his eyes and looked down, he saw that she had a more concerned look on her face.

”There were not a lot of bowel sounds down here and it is feeling kind of lumpy. Your so skinny, I think I can feel what I think is your sigmoid colon. Its a bit lumpy and distended. No surprise.”

She finished and pulled his shirt down. As she reached again to the table above his head, she went on, “Your skin is warm. Maybe from overdoing it last night, but with everything that is going on, I need to take your temperature.”

Alan had had enough time as a patient in childhood to to react viscerally to those words even though to most people , they would sound unthreatening and neutral. He watched with trepidation as Sarah opened a small plastic box and took out a glass thermometer. It had a skinny tapered tip with the remainder almost the thickness of Sarah’s index finger. He watched her wipe it with an alcohol pad she had torn open. When she turned to him without taking any additional steps to prepare the thermometer, he was relieved and opened his mouth with a mixture of confidence and hope.

Sarah slipped it under his tongue. As Sarah made some entries into her tablet, Alan thought to himself how foolish he was to be nervous about the thermometer. He’s an 18 year old college student, did he really think that she was going to put it in his butt?

After a few minutes, Sarah retrieved the thermometer. When she read it, Alan saw her perplexed facial expression. She adjusted the flexible armed study lamp on the table above his head to illuminate the thermometer better and looked again.

“95.0 F! ? ! Can’t be!.”

She looked at Alan and they exchanged glances for a few seconds and then they simultaneously looked across the room at Alan’s half empty glass of iced tea.

Their eyes met again. “Only one way around that my dear boy,” she said.

Alan felt his pulse quicken as Sarah got up and walked over to get her bag and he watched as she reached in and took out some small foil packets. He knew the implications immediately.

“I need to take it rectally, Alan. Its the only way we are going to get an accurate reading, and its important that I have a good baseline assessment of you. Turn around and put your head at the other end of the bed so that I can use the desk lamp to see.”

Alan didn’t move, “No, you can take it tomorrow, when I haven’t had anything cold to drink.”

Sarah quickly shot down the plea, “No. We had our talk and our agreement and now I need your cooperation. I’m trying to help you and you need be an adult now.”

Submitting to a rectal thermometer did not seem to Alan a fitting part of the transition to adulthood. He sat up and swiveled on the bed and then laid back down with his feet toward the table with the lamp.

“Turn onto your side a face away from me.“

Alan slowly did as he was instructed. Sarah adjusted the lamp so that the beam shined on Alan’s backside though it was still covered with his shorts. She then put her hand on his upper hip and said, ”Lift up your hips.” As soon as Alan did this, she grabbed the waist band of both his shorts and underpants and in an instant had them down to his lower thighs. Alan could now feel the warmth of the halogen desk lamp on the bare skin of his naked bottom.

Sarah looked at Alan’s bare behind for the first time. Skinny, pale, and cute; she thought. She felt a sense of pleasure. Not really sexual, but a satisfaction to be able to have her patient‘s trust in baring himself to her and submitting to her authority and to trust her enough to allow her to do this to him. All the more so that it was a shy male patient at one of the most self conscious and vulnerable stages of his life. It was in a way a very profound compliment and a type that she would never tire of receiving.

Sarah put on some purple exam gloves and tore open a packet of lubricant. Alan could not see this and was too embarrassed to look over his shoulder, but he recognized the sounds enough to know just what she was doing. The noises stopped and he could hear Sarah‘s breathing enough to know she had come closer up behind him. The bed was low and she was kneeling on the carpeted floor, “Now, bring your legs up a bit closer to your chest.”

Alan shifted his legs up awkwardly as the two bands of elastic encircling his legs restrained him partially. After he got his legs up, he felt the touch of her gloved hand on his upper buttock and as she grasped it and lifted it, he felt the cool air on the warm damp skin of what had been concealed. He expected to feel the poke of the thermometer any second, but there was a silent pause.

After a few seconds, Sarah spoke, “Alan, sweetie, you‘re a mess back here!”,

Alan was mortified and offered, “But .. I just showered an hour ago!”

”No, no, not that kind of mess, you’re perfectly clean.“. She rubbed his hip reassuringly. “It’s just that your skin is all inflamed. The crack of your butt is all red and chapped and your anus is all red and swollen. You must be so sore. You are probably dreading every time you poop. No wonder you are caught in a vicious circle with your bowels.”

”I’m going to put the thermometer in, so relax.”

Alan felt the moist cool tickle at the center of his hypersensitive anus and then a smooth firm presence fill the canal of his anus as the thicker part of the shaft glided into him. As he felt his ears heat up with embarrassment, Sarah released his buttock and it flopped down, holding the cool glass in place with it’s companion on the other side. She then pulled up a light blanket over him.

“After I get your temp, we will put together a plan to get your bottom healed up. Have you been having a lot of pain when you poop? “

”Some.” Minimizing his misery on the toilet helped him to answer.

“First thing we are going to do is get you an app on your phone that will help you keep track of your BM’s and your symptoms. It’s called GITracker. It will send me your data as your provider so that I can keep track too and guide you through this. Here, sign onto your phone and I will download it for you.“

Sarah reached over and put Alan’s phone in front of his face. He took it and opened it and handed it back to her.

”OK, let me get the thermometer.”

The blanket was lifted and the cool air returned onto his bare skin. In a second, the subtle presence in his anus was gone and he felt empty. The warm blanket returned. He rolled over onto to his back and watched with embarrassment as Sarah wiped the slick thermometer with a tissue and held it up to the lamp.

”99.0 F. That’s more like it.” She cleaned the thermometer with alcohol, returned it to the plastic case and then grabbed a felt tip pen and started writing on the case. She held up the case for him and he saw his name on it. “After that, this one is your thermometer forever!”

Sarah saw Alan wriggling with his hands under the blanket. She stopped him, ”Keep your pants down. I am going to do something about that irritation.“ She peeled off her gloves and went into the other room. This gave Alan a few moments to reflect on his situation and he marveled at how he had gone from trying to flirt with Sarah over beer last evening to lying in her dorm room with his pants around his knees having had her just spear his bottom with a thermometer.

She was back in a minute and visibly excited, “I found just the thing for you, Alan!” She was holding a plastic tube of medication. “Hydrocortisone ointment. It will be soothing when it goes on and will calm down the irritation and get your skin healed up. Roll back over and bring your knees up.“ She gave the order quickly and nonchalantly now as they both understood that her instructions would be followed faithfully.

The blanket was removed and she had new gloves on in a flash.

She spread him open again and began applying the ointment to the inner aspects of his buttocks and then the crease from his tailbone to the back of his scrotum. She then got a fresh dollop of the ointment and began gently smearing it over his anus. He flinched a bit and she saw his anus tighten up. “I know its sore Alan. Try to relax for me. “

He felt the gooey slipperiness increase and the soreness dissipate and was thinking the ordeal was about over.

”Alan, it will really help if I can get some of this ointment further up inside your bottom. That’s where a lot of your pain is coming from when you try to poop. I‘m going to go in very slowly and we can take a break if you need to rest. Remember, slow deep breaths.”

Sarah’s finger was back and focused right on the center of his anus. Just the tip making tiny circular massaging motions. “Deep breaths.” she reminded him with a whisper.

She ever so slowly increased the pressure she was applying with the pad of her finger, but she found she was making no progress.

”Sweetie, you are clenched up so tight, I‘m not getting any of it into where it needs to go. After every fourth breath, take a reaaly deep one in and hold it and bear down like you are trying to have a BM. OK?”

Alan started his breaths and Sarah counted them out loud. Her finger was back doing the mini massage. “Three… Four… now hold it and push.” When she felt his anus open slightly, she ventured in until she felt firm resistance and then retreated. They repeated this a few times. Sarah knew she was going to have to push more firmly still to fully penetrate him and she warned him that the next time he was going to go fully into his rectum. “Three… Four…. Push Push. “ She quickly increased the pressure and finally felt his tight ring yield and she was all the way inside him.

Alan, fearing the worst based on his experience at the student health center and the suppositories, was bracing himself. The full penetration took his breath away as it was certain to do, but it was actually not painful. Sarah’s finger felt like silk as it slid into him. She held it inside him and moved it around, gently feeling inside his rectum. This gave him a bit more of a full and need to use the bathroom unsettling sensation, but he stayed relaxed for her.

Sarah decided to take advantage of having her finger fully in his rectum and assess the situation within. She continued to feel around and was not surprised to be encountering large clay-like masses of stool Inside him. She started sharing her assessment aloud with him, “You have a really tight anus, Alan. I think that might not be helping. And, you are VERY full in here. You have quite the blocked up bottom.”

Alan was mortified to hear her describe all this. it reminded him of an episode when he was about 10 at his pediatrician‘s office. She had him on his belly frog legged on the exam table With her finger up his behind and was talking to Alan’s mother as they both hovered over him. He remembers her reporting to his mom how full and backed up she could tell he was with her finger.

Finally he felt Sarah’s finger exit his bottom. He was so generously gooped up with the ointment that things felt messy as she slid her finger out of him and he hoped that it came out clean.

“Things are worse than I thought. We need to work on this tonight. At least tomorrow is Sunday and you can rest and recover before you have to go back to classes. I need to go to the pharmacy to get some things. You can stay here and rest if you would like or go back to your room and I’ll text you when I get back”

Alan pondered this. It worried him that whatever she had in store for him, that he would need a day to “recover” as she put it, but he was feeling increasingly comfortable in her rooms and told her he would stay and wait for her there.