Alan’s Dormitory Medical Care

The Next Day

Alan dozed off again. When he woke again, the room was so bright, he squinted as he raised his head. Sarah was next to him and had a more serious look on her face, and began with a more serious tone to her voice, “Alan, Dr Young is here to see you. Its morning.”

Alan rolled onto his back and was surprised to see not only Dr Young next to Sarah, but Melissa was there as were four others in white coats — 3 women and a young man.

“Good morning Alan. The gastroenterology team is here with me on rounds to see you. Your fascinating and puzzling case is a good learning experience for them. Sounds like you had an uneventful night. That’s good to hear. No fevers, and no belly pain. Have you been passing any gas?”

Alan hesitated to answer with the semicircle of 6 women around his bed.

Sarah got impatient and answered for him, “He has, Dr Young.”

Dr Young looked at Sarah skeptically, so SArah elaborated, “I’ve been here through the night, he has been expelling flatus audibly quite often.”

Melissa confirmed this to back SArah up, “Yes, quite a bit.”

This discussion seemed like a mortifyingly inauspicious way to start the day for Alan, but Dr Young was pleased, ”Good! Flatus means peristalsis, which is a reassuring sign you are not developing peritonitis. Lay back so that I can examine your belly.”

She had the sheet down and the gown up in no time with one hand as she warmed the diaphragm of her sthoscope with the other. Alan peered down to see how expose he was. A few curls of pubic hair exposed, but that seemed trivial at this point.

Dr Young closed her eyes as she moved the stethoscope across his abdomen, “Bowel sounds active in all four quadrants.”

She then moved her hands over him pressing deeply and was further pleased, “Soft and non tender good enough for me. We will continue to monitor you through the overnight tonight Alan. If things are still going well, home tomorrow. We will have you start some clear fluids today. Your bladder feels distended. Have you been peeing?”

“Not much.” He quietly replied.

‘Well, try to go as soon as we leave. We don’t need another complication. Although you are on bed rest and don’t have bathroom privileges, you can stand next to the bed with the urinal to make it easier to go. Peeing supine can sometimes be more difficult. As long as Sarah or Melissa is hear in case you get lightheaded.”

She turned to her entourage, “Any other questions for our patient?”

There was silence. Dr Young turned back to Alan, “Alan, regarding the underlying problem that brought you to see me to begin with, the chronic constipation. I have discussed your case with Dr Guy Charpentier, a French colleague I met at a conference last summer in Switzerland. He specializes in neuromuscular disorders of defecation. We think you likely have a rare condition called puborectal dystonia. THere were findings on your exam yesterday that led me to suspect this, and when I describe your history and my findings with Dr Charpentier, he concurs that it is highly likely that this is the underlying problem. We need to do an additional test called a defecogram to confirm this. The good news is that this condition is very treatable with exercises and biofeedback. We can’t do the test for a week or so. We have to be sure that your bowel has healed sufficiently to tolerate the procedure. I will check up on you later today.”

With that, the team headed out. Melissa was the last one the leave and Alan caught glimpse of her face as she glanced back at SArah and with raised eyebrows at what Dr Young had just said. Alan accurately interpreted this as a sign that his ordeal was nowhere near over. He turned to Sarah with a despondent look on his face, “Sarah, what did that mean? What’s that test she mentioned?”

”Alan, the important thing is you are doing well. We need to focus on that. One day at a time. We can talk about the test after you get discharged.”

Melissa returned a few minutes later holding a sealed clear envelope in her hand. Inside, Alan could see a coiled amber strand about the thickness of a pencil. With a smile beaming on her face, she began, “Hey guys! Good news! Dr Young has overruled policy and given us the go ahead to use a leave-in temperature probe.”

Alan did not understand and turned to Sarah. Grasping his puzzlement, she explained, “Its a thermometer that can be put in your rectum and left there, so there’ll be no need to be getting poked in the bottom every hour all day and all night.”

Alan was not sure how much of an improvement this was.

Melissa put some gloves on and tore open the package and put it on the bed next to Alan, “Alan, roll over so I can insert it, then its done.”

Alan did as he was told. Melissa gently pushed his upper leg up and forward, flexing him a bit at both the hip and the knee. He could then feel her spread his buttocks apart. This was the first time Melissa was looking at his bottom so intently without him being distracted either by the sedative he had overnight, or the fear and panic when he first arrived the previous day. The embarrassing intimacy of it was intense, all the more so as he saw Sarah in front of him watching his facial reaction and then looking up at Melissa. “Do you need another packet of lubricant, Melissa?”

“No, there’s actually still plenty here. “

She picked up the probe and got a firm grip on the 2 inches of the tip with he thumb and index finger, “Here it comes Alan, okay?”

Alan felt the tickle of it slithering into him just as he looked up and met Sarah’s eyes as she intently observed his facial expression. She could see his countenance change subtly, but abruptly just as the probe penetrated him.

Once Melissa had it positioned where she wanted it, she stripped off her gloves and reached into the front pocket of her scrubs for a roll of tape, “Stay still, Alan. I need to put a few tape strips here to keep this in place.”

She tore off two short strips of tape and used these to secure the external part of the probe first to the skin of Alan’s right buttock and then further out on the back of his upper thigh with the second piece of tape.

“OK, you can roll over onto your back.” As he did this, she covered him back up with the sheet. She plugged in the metal tip of the probe lead to the bank of electronic monitors above Alan, producing three quick beeps.

Melissa looked up at the monitor, “99.0 F. All set. You can get some undisturbed rest now!” She zipped out of the room, leaving Alan alone with Sarah.

Sarah got up and went into the adjoining lavatory and came out with a plastic urinal and laid it on the bed next to Alan, “Get up slowly. You need to empty your bladder or you’ll wind up with something up another orifice.”

Alan carefully swiveled 90 degrees, but had to go cautiously with the thermometer probed taped to his bottom so as not to dislodge it with friction from the bed. He dangled his legs as he sat for a few seconds and then took hold of Sarah’s hand that she offered to help him rise.

“Alright, here, take the urinal with your left hand and I will steady you on your right. You shouldn’t have any stage fright with all that we’ve been through together.” She leaned forward and turned to look into his face when she said this so that she could share her lighthearted smile.

Alan took the the urinal and positioned it. Peeing was not really something that embarrassed him much compared to things with his bottom and bowel function. He had peed in close proximity to many girls at informal outdoor beer parties in high school. His stream started quickly, producing at first a hollow drum roll sound as the stream blasted at the bottom of the plastic urinal, then transitioned to more of a splashing sound rising in pitch as his urine began to fill it. Just based on her audible impression, SArah was impressed, “You sure don’t pee like an old man, Alan. More like a thoroughbred. No catheter for you!”

Alan felt some pride well up inside him at these words. He finished quickly. When Sarah no longer heard any more noise coming from under his gown, she put out her hand, “Here, hand it off and sit back down.”

Alan handed the nearly full urinal to Sarah.

“1200 cc’s. Well, I guess we back off on the IV fluids.” Sarah shook her head in disbelief as she walked back into the lavatory to flush the contents.

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