After Melissa left, Sarah stood over Alan. Seeing the worried look on his face, she tried to calm him, “Try to rest Alan. Close your eyes for a while. I‘ll turn off the ceiling lights for you. You’re in good hands and worrying isn’t going to help.”

When Alan turned to look at her, Sarah could see his lower lip and chin quiver and his brows droop. She stroked his hair and told him again to close his eyes. He did, but he continued to sigh every minute or so, tossing around in the bed as he did so and making his distress obvious.

Sarah walked to the door and poked her head out Into the corridor. Melissa was seated there at a small desk typing her admission note into Alan’s chart. “Hey Melissa! I know you are busy, but he’s miserably anxious. Could you ask for an order for something to calm him?”

”Sure, I’ll ask the covering resident for a prn lorazepam order.”

”Thanks. I‘m so glad he’s your patient but the way.” Sarah tilted her head and smiled appreciatively at Melissa.

Melissa returned the smile, but then got a curious expression on her face, “Your two know each other I guess?” She nodded towards towards Alan’s room as she asked.

”He‘s a freshman in my dorm. We got to be friends a bit. I’m the RA for the wing he is on.”

”A bit? I guess.” Melissa said as she smiled again, but both of them understood that this was not really an adequate explanation. A male freshman was not going to consent to have his attractive female RA present while he gets his temperature taken rectally, whether they are “friends” or not. Melissa was familiar with Sarah‘s bedside manner enough to know she was very good at disarming the defenses of even the most withdrawn or nervous patient and securing their trust and cooperation, but this still seemed a bit hard to believe. Nevertheless, she liked Sarah a lot and she was not going to pry any further.

Melissa looked back at the monitor in front of her, “Lorazepam 2 mg IV. Well, I was hoping for maybe 0.5mg sublingual, but this oughta work quite nicely. Thank god for senior residents. They’re more confident and generous with sedatives. They quickly get tired of being paged for more every 30 minutes if they order skimpy doses. I will be right in with it.”

Sarah returned to Alan’s bedside and took his hand, “Alan, Melissa is going to be in with something to help you relax.“

Melissa came into the room in a few minutes and seeing Alan’s worry ridden face, gave him just a warm ”Hey there, Alan. This will help. I promise.”

She scanned the barcode on his plastic ID bracelet and then the sticker on the syringe. She scrubbed the plastic hub on his IV tubing and slowly emptied the contents of the syringe into it.

In less than a second, Alan felt like he was melting. He had been holding his head up to watch Melissa working, but his head flopped down onto the pillow involuntarily. All at once, it felt like gravity became stronger and pulled his limbs into the softness of his bed. The sounds of the room became more distant and hushed and the light seem to softly dim. He turned his head to look at Sarah. Seeing the tension dissipate from his face, she smiled both to reassure him and out of satisfaction at seeing the rapid results of her suggestion put into action, “Good! It’s ok to close your eyes and rest now.” Alan’s eyes were closed before she finished the sentence.

”Mission accomplished!” pronounced Melissa as she dropped the syringe into the sharps container on the way out the door.

Alan wasn’t out cold. He would respond to Sarah‘s questions by nodding or mumbling yes or no. Other than that, he layed there perfectly still with his eyes closed, breathing slowly and deeply. Sarah watched the monitor over his head with satisfaction as his pulse rate steadily crept down from the low 90’s to the low 60’s. Knowing she could do no more for his comfort at this point, she let go of his hand and took out her phone to check messages.

Melissa was back sooner than Sarah anticipated with the thermometer in hand.

”Already?!” Sarah whispered.

”I know. An hour goes by fast. Just when he is able to rest a bit. I don’t know whether its better to wake him and warn him or to use stealth.” Alan was already on his side facing Sarah, so the second option was theoretically possible.

Sarah considered the two choices. “How about a little of both? I‘ll give him a gentle warning as you go to work.”

Sarah bent over Alan and got very close as she whispered, “Alan, Melissa has to take your temperature again. Stay still, she’s going to uncover you now.”

Melissa pulled down the sheet. The gown Alan had on was rolled up in a ball in front of his belly, covering nothign more than his shoulders and his arms. His legs, hips, buttocks and back were bare to Melissa. He moved his upper arm in a clumsy futile effort to cover himself.

“OKay Alan, you’re going to feel the thermometer go in your bottom now. Stay still.“

Melissa was able to do this easily as the cleverly designed thermometer had an LED that shined down the length of the skinny shaft, illuminating the target. She accurately aimed for the center of Alan‘s anus without poking him, but he nevertheless reacted to the intrusion with a muffled moan and awkwardly tried to swat with his hand behind him. Sarah grabbed his arm and held it firmly at his side, reassuring him, “Its just the thermometer in your bottom, Alan. Relax And stay still. Just a few minutes.”

”It would be nice if you guys could use a leave in place probe so as not to disturb him every hour,” Sarah wondered out loud.

“I would be, but we’re not cleared to use them on this unit. Only the ICU’s are allowed to use them,” Melissa answered as the unit beeped and she swiftly withdrew the shaft from Alan and covered him back up with the sheet. Let’s try to just keep him resting in a position that gives me good access. I am actually going to switch to a glass thermometer. We have them on the unit after we had a patient who insisted she was allergic to the plastic probe covers. I think it would be best — smoother, blunter. Less chance for an ouchy poke. His bottom looks pretty sore. Its visibly red at the anterior edge of his anus.”

“That sounds like a great idea. His little bottom has been through the ringer today.” As she said this, Sarah realized her admiration for Melissa continued to grow as she watched her work.

Alan was just aware enough of his surroundings to hear this conversation. To hear Sarah and Melissa planning on how to provide his care most comfortably gave him a sense of even deeper tranquility and security beyond what the lorazepam had induced.

The day turned to evening. The wisdom of the plan Sarah and Melissa formulated became apparent. Sarah helped keep Alan resting in a position that allowed Melissa easy access to his bottom. They tried to keep the room dim, but this presented a challenge for Melissa as of course, the glass thermometer she switched to had no light of it’s own. To solve this, Sarah would come around to the other side of the bed and shine the light of her phone between Alan’s buttocks when Melissa would spread them, allowing an accurate insertion every time. Melissa would then keep one hand firmly on Alan‘s hip in case he tried to roll over. The other hand she would keep cupped over his bottom with the thermometer poking between her middle and ring finger.

Alan stayed calm and still for the most part. He would occasionally whimper when the tip penetrated him. It was not out of discomfort, just the instinctive protest to the experience of having something slide into his rectum.

As the night wore on, the lorazepam started to wear off. Alan woke up startled and afraid. The room was rather dark — just the monitor LEDs above his head and some light coming in from the hallway. Sarah had fallen asleep seated in a chair pulled up closely next to the bed with her head resting on the bed in front of Alan. She was turned so she was facing towards his feet. Her hair was inches from his face. As he tried to calm himself, he focused on his breathing and so became aware of the now familiar scent of Sarah’s hair. Far more than his own conscious effort, this soothed and comforted him. He was not able to fall back asleep, but he was able to lay there calmly and he started to contemplate the astonishing events of the past 18 hours.