Alan slept poorly despite all of Sarah’s reassurances. He finally gave up shortly after 5 AM and got out of bed. He had breakfast in the dining hall. Usually he would have 2 cups of coffee, but he was so anxious, he skipped it. The coffee would usually trigger his morning bowel movement and there was a single room lavatory off one of the lounge areas in the dining hall that he would go to for privacy as it was always free with no one in he lounge in the morning. He went there out of habit and went in, but he then realized without his coffee, he was going to have trouble. He tried, but could not have a BM, passing only small amounts of gas. He started to panic as he thought about how much more embarrassing and possibly more uncomfortable his day with his new doctor could be if he was obviously constipated. It was no use though, and he returned to his room to shower. He washed his genitals and bottom thoroughly knowing what was in store for him in the hours ahead. He took the bus to the medical center and checked in at the registration desk in the lobby and was sent up to the 4th floor to the gastroenterology department. When he arrived, the waiting room was already nearly full and he had to stand in line behind two other patients to check in with the GI receptionist. He was given some forms to fill out with the types of embarrassing questions he had expected. He had not gotten half way through when he heard his name called. He looked up and saw a nurse in blue scrubs. They made eye contact and she said, “Come back with me, I’m Morgan. Nice to meet you. It looks like you have a lot going on. I‘ll get your vital signs and get you ready.“ She walked quickly as he followed her through a series of bare tiled hallways until she stopped at an open doorway and motioned him in with her arm.

Alan went to sit down, but Morgan stopped him, “Don’t sit yet. Here’s a gown. Get undressed and put this on opening in the back. You need to take everything off.”

She put the folded gown in his hands and was quickly out the door. The fast pace of everything was unsettling to Alan and he felt like he had to undress quickly, expecting Morgan to be back shortly. She was, and he had to quickly turn around to face the door when he heard her knock. He had not even answered as she let herself back in and closed the door.

“Weight first. Hop up on the scale.“

Alan felt the cold tile floor under his bare feet as he obeyed, holding his gown closed behind him. Morgan noticed this and commented, “You are in the wrong place for shyness and modesty.“ She shifted the metal weights around on the scale for a few seconds and then had him go back to the exam table. She took his pulse and blood pressure without a word and then picked up the electronic thermometer unit and flipped it on with a beep. ”I need to take it in your bottom. THat’s the way the doctor your seeing insists it be done. Lay back and roll onto your side.” Alan looked at her. She was attractive with straight blond hair and blue eyes, maybe a few years older than he was. She had not smiled once yet. Alan did as she asked with a sigh of resignation.

She came up behind him and unwrapped with gown, exposing his pale bottom. He felt the cold air. She put down the thermometer unit and then used her hands to flex his upper leg up and tilt his hips a bit forward. It was one of the positions Sarah would use to gain access to his anus. Morgan was much more heavy handed and impatient. He tried to cooperate put she kept pushing him into a more awkward pose. When she was finally satisfied, he could feel the cool air now touched the area around his anus as she achieved her goal of exposing him.

“Here comes the thermometer. Stay still.”

Alan noticed the thermometer felt thin at first as it slipped into him, but then he felt a surprising amount of deeper pressure. It occurred to him that this was because his rectum was full. A sense of dread came over him as he became aware of Morgan having to push harder to get the thermometer to penetrate to the depth she wanted.

She uttered a puzzled “Hmmm” and let go of it.

It beeped after a couple of minutes and she pulled it out, and again, they both noticed that it did not slip back out as easily as expected either.

She understood when she held up the thermometer and inspected it.

”It’s got quite a bit of your poop on it. You must be pretty constipated. When did you last have a bowel movement?”

Alan rolled over and sat up in time to see her ejecting the soiled plastic probe cover into the trash bin. “Yesterday, but not very much,” was his answer.

”I’ll say. Well, you’re in the right place. That’s for sure. Dr Young is going to be taking a look up your bottom today, but we will certainly need to get you cleaned out before that. My guess is you’re in for a long day. Let me talk with her and see how she wants to get you prepped. You can sit in the chair if you want. Here’s a tissue if you want to clean your bottom.“ Morgan walked out. There was no smile, no words of reassurance, and the only physical contact had been perfunctory and rough. The contrast with how Sarah had cared for him was stark. Alan got his phone out of his pocket to text her, “Where r u? Its 9:45 already.”

Sarah responded in less than a minute, “ Stay calm. I‘ll be there in about 20 minutes. Who are you with?”

”Morgan”

The delayed response from Sarah to his answer seemed ominous to Alan.

Finally, she responded, “Okay, hang in there.“

Alan thought about how he might try to escape from having Morgan do to anything to him. Make a trip to the restroom? Before he could formulate a plan, there was another knock on the door. In walked a woman in her 40’s with a white coat. Alan recognized Dr Young from the photos online he had seen of her. Her hair was longer than in the photo and she was taller than he expected. Morgan followed in behind her. “Hello there, you must be Alan. I’ve been hearing about you. Sit down and let’s talk.”

Alan sat and Dr Young pulled up a stool and sat facing him. Morgan stood next to her, facing Alan.

”Morgan tells me that the constipation you’ve been having is still an issue this morning. After I do my exam, I will be taking a look inside your rectum with a proctoscope. Have you ever had that done before?”

Alan nodded no.

”It‘s not so bad, but needless to say, it can’t be done if your rectum is full of stool. Morgan here is going to give you a series of enemas to get you cleaned out so that I can get a good look. Right Morgan?”

Morgan nodded her head up and down as she stood with her arms folded looking right at Alan. She had a serious look of determination on her face.

“First, I am going to do a preliminary rectal exam to see what we are up against. Have you ever had a rectal exam before?”

“Yes.” Alan replied.

”Okay, then you know it can be a little uncomfortable, but really not bad. When did you have one before?”

Alan realized he shouldn’t bring up what Sarah had done, so he referred vaguely to once in his childhood.

”Okay, so you know what to expect to a degree. I will keep you informed of exactly what I am doing along the way. It always helps to know what to expect and have no surprises. It’s especially important since you won’t be able to see what I am doing and it is such a sensitive part of your body. All these things can trigger anxiety which can cause the muscles in your anus tighten and make the exam more uncomfortable. My goal is to prevent this negative spiral from happening. Come on over so we can get you positioned on the exam table.”

Alan did not find Dr Young warm and fuzzy, but she did seem considerate and wanting to keep him comfortable. She also had a calm air of confidence and competence and also eased his worries somewhat.

“Morgan, help him get into the Sims position with back arched and belly pushed forward so his bottom sticks out.”

Morgan patted her hand on the paper that covered table to signal to Alan she wanted him up there. She pulled the string on the back of his gown as he was climbing up, undoing the knot and letting the sides part. She guided Alan into the position he had been in for his temperature, but then pushed and pulled more, “Push your belly forward and arch your lower back. She really wants your bottom sticking out.” Alan hated this, but he wanted his new doctor to see him as cooperative, plus Morgan was no nonsense. As he got into position, his anus felt even colder this time as there was still the cool evaporating water based Surgilube on him. He thought how it was rather remarkable how his medical providers always seemed to get him exposed to their liking and the coolness on his anus was always the signal to him that they had succeeded.

Alan listened to the two of them preparing things on the tray behind him and then Dr young spoke, “Alan, I am going to start. First I am just going to take a look outside, so you will just feel my hands.“

He felt a hand firmly on each of his buttocks and then felt them spread wide.

”Alan bear down like you are trying to have a bowel movement.” As Alan reluctantly did this, he peaked over his right shoulder and saw Morgan right next to Dr Young staring intently at his spread bottom.

”Next I am going to insert my finger inside you. First you will just feel the tip. When you feel that, bear down again. Doing that will relax the muscles of your anus and allow me to penetrate you more comfortably.“

Alan felt her cold gooey finger tip and pushed as he was told.

“Good! Here comes my finger. Keep pushing.”

So far, it was not so bad for him. No pain, just the mortifying embarrassment of two women behind him doing this.

“Okay, my finger is inside your rectum. I am going to insert it fully now, so you’ll feel a bit more pressure and you may feel like you need to defecate. You won’t”

As Dr Young proceeded, both she and Alan were surprised. Alan because he quickly felt a strong uncomfortable full pressure in his rectum that he did not expect. Dr Young, because she immediately encountered such a large amount of stool in Alan that she could not advance her finger. “Well, you are much fuller than I anticipated. This may be beyond what we can clear with just a few enemas. Morgan, I think he may need to be manually disimpacted. Have you ever done that before?”

”I have, Dr Young. Multiple times.”

“Okay, then lets go that route. Try to push plenty of petroleum jelly up inside first. WIth what we need to do today, we need to try to keep him from getting too sore.”

Alan didn‘t understand what they were discussing, but he was not happy to hear about the vaseline and that it would likely make his bottom sore. He had been through that a lot over the recent months.

”Alan, I am going to slowly take my finger out of you now.“

Alan felt the slippery sliding feeling in reverse, but with a warm gooeyness rather than the coldness when it went in.

Alan sat up as the two women stripped off their gloves. Morgan turned to Alan and handed him some tissues again, but this time they exchanged no words about it.

”Alan I need to get some supplies and then I’ll be back and we will get started. I am going to bring a medical assistant to help me.“

Morgan and Dr Young left. As soon as the door was closed, Alan grabbed his phone and sent Sarah a frantic text, “WHERE ARE YOU? Morgan is going to do something to me, they called it disimpacting or something like that. It doesn’t sound good.”

”I’m almost there. Coming as fast as I can.”

That Sarah was rushing heightened Alan’s foreboding dread.