It was 7:30 when Dr Reed arrived home. Actually this was a little earlier than usual but for several reasons he was thrilled. First, he had a weekend off. Normally he was responsible for rounding on his own hospitalized patients, and for taking hospital calls regarding developments in their condition. And, he also received calls from his office patients who were had questions or difficulties. These things ordinarily took up at least a couple of hours each Saturday and Sunday but this weekend he was off! He had just hired a new doctor fresh out of his internal medicine residency and for the first time in years he could look forward to more time to himself.

Not that he had plans. John Reed's life was his practice. Sadly his wife Marlene had passed away from breast cancer three years ago and their 3 kids were all out of the home. Two were married and the third was in college, hoping to get into medical school. Dr. Reed's home was way bigger than he needed and felt kind of lonely but it held too much sentimental value for him to consider selling it. He was considering what to do about dinner when the phone rang.

"Hello", he answered, instantly thankful it wasn't his exchange.

"Oh Dr Reed, I'm so sorry to bother you. This is your neighbor Kristen. I need some help."

He was too engaged in helping people to not respond to Kristen. ""How can I help Kristen?"

"I'm having such a tummy ache. I don't think it's anything serious and I don't want to go to the ER but I'd feel so relieved if you could check me. I hate bothering you but... could you please..."

"Of course Kristen. I'll grab my bag and be right over." He hung up the phone, grabbed his medical bag and was out the door like so many other nights. "Some night off he thought " as he walked next door. He didn't really know Kristen Welker well. He and Marlene had socialized at neighborhood events but nothing since his wife passed. He did know Kristen was about 40, maybe 5 years younger than the doctor. She was also divorced and attractive.

He rang the bell and was immediately greeted by Kristen wearing a bathrobe. "Oh doctor, thank you so much. Please come in." She walked over to her sofa and sat down, appearing to be in modest discomfort with her hands holding her abdomen.

"When did this begin Kristen?" "This morning Doctor. It's been getting a bit worse as the day has gone on."

"Any nausea or vomiting?" "No, none" she replied.

"What's the pain like?" "Kind of crampy" was the response.

"When was your last bowel movement?" "Well, this is a bit embarrassing but not for several days."

"Is that common for you Kristen? She answered"Not really this bad but I do take laxatives every few days. They didn't help this time."

"Let's examine you. Perhaps you can just lay on your back on your sofa there and open your robe." "Of course " she said as she opened her robe to reveal a toned and tanned abdomen and laid back.

Dr. Reed placed his stethoscope in his ears and placed the diaphragm on her belly as he said"let's start with having a listen." After listening in all 4 quadrants he said"Your bowel sounds are normal. Now I'm just going to palpate your abdomen." Using his flat hand he felt gently in all 4 quadrants, then repeated the exam with deeper palpations.

"The only thing I feel is some stool in your colon in the left lower quadrant Kirsten. There's no guarding to suggest any inflammatory process. Now I need you to turn on your left side and push down your panties please so I can perform a rectal exam." "Oh doctor, is that really necessary?" "It is " he responded as he pulled a latex glove from his bag, pulled it on his right hand and applied a packet of KY gel to his index finger.

Kirsten did as requested and Dr Reed gently placed his hand on her upper cheek and spread it to expose her tight anus. He placed his index finger at her orifice and told her to take a deep breath and bear down as he began gentle steady pressure. The external sphincter began to relax and then his finger disappeared inside her rectum as she gave a grunt. "Oh doctor! " she said. He noted that the way she said that indicated it was not an altogether unpleasant experience for her.

He probed deeply and felt nothing abnormal except a considerable amount of firm stool. There was no pain elicited and he slid his finger out as he said "Kirsten, everything seems normal except for a lot of stool. I think this may all just be constipation but I'm going to check your rectal temperature so just stay like you are."

"Of course Doctor if you think that's the best way. To be honest that's how I take my own temperature. My mom always said it was the most accurate." Dr Reed retrieved a rectal thermometer from his bag, shook it down, dipped it in a packet of KY and spread her cheeks apart again. He placed the stubby bulb at her bottom hole and gently slid it inside as he warned"This may feel a little cold at first." "I know " she responded. "It always does. I leave it in for five minutes. Is that right?" " I agree " the doctor said as he checked his watch. He looked around the living room but couldn't help but note the attractive bottom in front of his eyes with the red tipped rectal thermometer between her cheeks.

After 5 full minutes he slid the thermometer from Kristen's rectum and said"100.1 Kristen. That's a normal rectal temperature. " He wiped some fecal material from the thermometer and gave her his diagnosis: "This is all due to your constipation Kristen. Frankly the best way to deal with this is to give you an enema."

"Oh gosh Doctor. If you think that's best you can use my bag." "Do you want me to give you an enema Kristen? You can do it yourself if you'd like." "I'm just so uncomfortable that it would be so much easier on me if you could help me with it. The equipment is just hanging in the bathroom off my bedroom."

John walked into her bedroom and the bathroom and indeed noted the red latex 2 quart enema bag hanging in the shower with it's red hose and black batwing nozzle. Maybe this wasn't going to be so bad after all he thought as he took it down and filled it fully with warm water before returning to the living room. He brought a towel to put under the patient.

"Alright Kristen, lets have you come into your bedroom and lay on your left side on this towel. Not so far to the bathroom that way and I can hang the bag on this hook I see you have here on your bedpost." Kristen's face flushed as she laid down as instructed, saying "Well, I do have to occasionally give myself an enema it's true. I just didn't think that was what I needed this time but I'm so appreciative you were willing to come help me." She laid down on her left side, pulling her legs up a bit into Simms position. She reached back with her right hand and spread her cheeks for him. Doctor lubricated the nozzle and placed it at her opening. He applied genital pressure as he asked Kristen to take a deep breath and bear down. The nozzle slid into her rectum. "I'm going to open the clamp now Kristen. Let me know if you need to have the flow slowed or stopped." "Okay Doctor."

Kristen took the full bag with minimal discomfort. As it neared the end she said"I've really got to go Doctor. Please take it out now." She moved briskly into her bathroom but left the door open. Within seconds the sounds of evacuation could be heard, both water and solids. "I'm sorry Doctor. I'm so embarrassed but I needed this." "Not a problem Kristen. I'm going to just leave you alone to finish up. Glad I was able to help. I'll check on you tomorrow to be sure you're all better. Let me know if you have any more problems tonight. " Dr Reed picked up his bag and stepped into the night air. "Wasn't that an interesting development " he thought.