Amy was well and truly fed up. Following her recent emergency surgery, there was no way she'd be able to wear a bikini again. She'd been so proud of her body and had both eaten sensibly and exercised to keep herself in a trim, slender shape. Now that had been all for nothing. She'd developed toxic megacolon and had to have an emergency ileostomy. She'd started off with a pain in her abdomen which became worse and worse. Her abdomen started to swell alarmingly and she'd been very, very sick in the ambulance on the way to hospital.

In the Accident and Emergency Department, she'd been seen by the triage nurse who had placed her as top priority, sending her straight to the Resus Room for immediate attention. There she'd been hooked up to monitors and a line put in for fluids. The doctor who looked at her prodded her abdomen which by now made her look several months pregnant, causing her to throw up again all over the floor.

After she'd been washed and put into a clean gown, she'd been taken for X-ray. She had had two films taken: one lying down and one sitting up, the second causing her to retch weakly, producing just bile into the vomit bowl which the radiographer had had ready.

Back in the Resus Room, the doctor looked at her X-rays and phoned theatre to arrange for an emergency laparotomy. Amy signed the consent form, and was warned that she might end up with a stoma. To her horror and initial disgust, she has had most of her colon removed, leaving about six inches of rectal stump and anus, and an ileostomy sprouting from the right side of her abdomen, encased in a clear plastic bag.

Her smooth abdomen was ruined by an incision from above her navel, skirting around her navel to just above her pubic hair and closed with a row of close spaced clips which looked like the teeth of a zip. She had the indignity of a urinary catheter, a tube up her nose into her stomach, oxygen mask and several cannulas in both arms providing her with the patient controlled analgesia and fluids to hydrate her as well as antibiotics to prevent post-operative infection as she'd not been able to be prepared for the surgery in the normal way. She felt less than human &ndash a 'thing' with all these pipes and tubes in her.

She cried again to herself as she thought of what she'd been through, even two months down the road. Her abdomen had healed into a raised puckered scar and even the knowledge that the surgery had saved her life was small consolation for having the stoma with its pouch to collect waste which needed emptying so many times a day. She associated such things with old people, not twenty year old young women.

She was waiting for the district nurse or one of the community nurses to come to give her a rectal washout. Her rectum had been left in place in case she wanted an ileo-anal anastomosis to be joined up with the formation of a pouch made from her small intestine connected to her anus so she could get rid of waste through the conventional opening. She'd done her research thoroughly and learned that many people have problems with that &ndash a condition known as pouchitis where the internal storage pouch becomes inflamed and painful &ndash so that they had to go back to their ileostomy having had three or four major operations. Amy had hated being so dependent in hospital and the long convalescence afterwards. Amy was still not fully recovered from the surgery as she'd developed an infection post-operatively and had been very poorly for some time. She decided that she'd stay with her ileostomy, at least for the time being, as the less of evils.

It was the senior district nurse, Sue, who came that day. She was well aware of Amy's mental state and felt sorry for her. She had decided that she would try to get Amy out of her depression by giving her something to 'take her out of herself', or, at least, that's what she hoped.

After she'd done the procedure, she waited, unusually, until Amy had been to the toilet afterwards. When Amy came back into her bedroom, still with the table set up with the jug of warm water, thermometer, rubber gloves and KY jelly and the plastic sheet with incontinence pad on the bed, the nurse spoke to her.

“Amy, we have several patients who need similar procedures to yours and we've decided to make a series of videos to show new nurses how to carry out the procedures. Let's face it, you've got a much better body than any of my other patients and I wondered if you'd be willing to help?”

“What would it involve?” Amy asked.

“Well, in a fortnight's time, instead of coming here to carry out your washout, I would pick you up to take you to the hospital where one of the medical photographers will film it for us, edit it and transfer each section to a DVD for the nurses to study before carrying out a new procedure. When we've finished, I'd bring you back here. We'd be gone all morning, I'd expect. What we won't be doing is showing your face at all, so there'd be no privacy concerns on that score.”

“OK,” Amy replied, “I'll give it a go.”

By the following fortnight, Amy wasn't so sure that she was doing the right thing, but it would be a bit wimpish to back out at this late stage. The doorbell rang and the district nurse stood at the door.

“Amy, would you bring with you a change of ileostomy pouch and wafer as we'd like to do that on the video, and we need you to bring one of the red rubber catheters which we use for the washout. The hospital has everything else ready for us.” One of the community nurses, Emma, was in the car waiting for Amy and it was explained that both nurses would be 'starring' in the video for various sections.

At the hospital, Amy was surprised when they didn't go to the surgical ward where she'd been after her operation, but headed instead for one of the respiratory wards.

Once in the ward, she was led to a side room with 'Sleep Study' on the door. The district nurse noticed Amy reading the sign on the door. “We're using this room for several reasons. Normally it's used for people to spend the night to be monitored for sleep apnoea, but it's been set up like a bedroom with a divan bed, not a hospital bed and there are video cameras in here anyway so it's ideal.”

Amy was introduced to Julie, the photographer from the hospital who was to make the video.

Julie explained, “We thought you'd be happier with me, rather than my male colleague.” Amy was very happy to agree with that!

Sue held out a hospital gown for Amy to put on. “Would you remove all of your clothes, except for your bra, if you want to keep that on, and put the gown on? We did discuss using a nightdress for you, but the hospital gown is probably better to let us show what we need.

Julie explained that the three fixed cameras in the room would be recording and she would more around with a portable camera for close-ups. Amy changed into the gown with its open back closed by tapes. As she didn't need a bra, she was naked underneath and stood there while Emma pulled back the covers on the bed and protected the mattress with a plastic sheet and incontinence pad.

“My,” asked Sue, “I'd like to start by putting a urinary catheter into you as the first demonstration. I'd like to leave it in while we do the washouts and then take it out when we've finished. Would that be all right?”

“What do you want to put a catheter in for?” Amy asked.

“Well, it's one of the procedures we want to have on video and I hoped you'd agree.”

Sue replied. “I've had a catheter in when I had my surgery, but that was put in while I was in theatre. I've never had one put in while I was awake before.”

“Don't worry,“ Sue replied, “it won't be painful, I promise. Please, we'd be very grateful.” Amy was well aware of the emotional blackmail which was being applied to her, but she did agree, albeit somewhat reluctantly.

“Would you lie on your back on the bed, please Amy?” Emma asked. Amy did so and, while Julie filmed this, Emma, who had donned rubber gloves and clear plastic apron, pulled Amy's gown from under her so that she was lying directly on the incontinence pad. Emma explained that that was so her gown would stay dry. Sue then set out on a stainless steel trolley the items which Sue would need to catheterise Amy.

Sue placed a catheterisation pack, a tube of Instillagel, a 14 FG all silicone catheter which she peeled back the top of the catheter's sleeve, a plastic container with 10 ml of sterile water in it, a 10 ml sachet of sterile saline, a 10 ml syringe, a 2 litre sterile night drainage bag which she opened and a disposal bag. Sue also was wearing an apron. She went to wash her hands and dried them thoroughly, all the time with Julie videoing close ups of what she was doing.

Sue then opened the catheterisation pack and carefully put on the pair of sterile rubber gloves from the pack. She turned to Amy and asked, “Would you spread your legs as far apart as possible, then, keeping them apart, bring your heels up as far as is comfortable to your buttocks so that your knees are in the air?” Amy did as she was bidden, but felt very vulnerable lying there like that.

Sue placed the sterile field ( a sterile sheet of special paper) from the pack on the bed between Amy's legs and placed on it the receiver ( a grey cardboard tray), a plastic container with cotton wool swabs in it, a pair of tweezers and another cardboard tray. She picked up the catheter's inner sterile bag, being careful not to touch the outer packing, and placed it in the receiver. She then pulled the tip off the plastic bag, exposing the blue silicone rubber catheter tip and applied Instillagel from the syringe to the tip of the catheter. She placed both catheter and syringe in the receiver.

Meantime Emma carefully filled the syringe with the 10 ml of sterile water. Julie was careful to video each relevant part of the procedure. The video would later be edited and the sound track, explaining what was happening, added later.

Sue sat on the bed between Amy's legs and slid the sterile field until it was nearly, but not quite, touching Amy's bottom. Emma pulled back Amy's gown exposing her womanhood which was shaved smooth and hairless.

Sue took the tweezers and swabbed the outside of Amy's labia with a cotton wool swab, dipped in the sterile saline which Emma had poured from the sachet. Sue the parted Amy's labia and swabbed three times from front to back, using a clean swab each time.

Finally she picked up the syringe of Instillagel and, with a warning about what she was going to do to Amy, squirted a little on the opening to Amy's urethra, leaving it for a few seconds for the local anaesthetic to start to work. She then inserted the tip of the syringe into Amy's urethra and squirted the rest of the anaesthetic, anti-septic lubricant gel into Amy's urethra. Amy gave a little gasp as it stung at first, then went numb. Sue kept the syringe there for minute to hold the gel in to allow it time to take effect, then, placing the now empty syringe in the disposal container, picked up the catheter by its sterile inner bag with the end in the receiver and inserted it into Amy's urethra.

There was a slight resistance as it passed the sphincter muscle of the bladder outlet and suddenly urine began to flow into the receiver. Emma first inserted the 10 ml syringe into the catheter inflation point and injected the 10 ml of sterile water to inflate the balloon to hold the catheter in place. She then took the open end of the catheter and pushed the connector from the night drainage bag into it. Sue used a couple more swabs to wipe away some of the gel which had leaked and then removed the sterile field and contents into the disposal bag.

“Well done, Amy. You can put your legs down now.” Emma rearranged the catheter and hung the night bag from a stand at the side of the bed.

“Next I'd like to to an anal dilatation and then one of your washouts. I'm afraid you'll have to use a bedpan as the toilet is some distance from here, but we won't be videoing that!” Sue set out the cone shaped dilator and a tube of aqueous lubricating jelly.

“Would you lie on your left side with your knees up, please?” Sue asked Amy.

Amy obliged her, with her bottom exposed at the edge of the bed. Sue gloved up, putting two gloves on her right hand. She lubricated the dilator and placed it in a disposable receiver and then lubricated her middle finger of her right hand in its glove. She then gently inserted it into Amy's back passage, then replaced her finger with the white nylon dilator, inserting it as far as the ridge at the wider end while Emma times a minute as Sue held the dilator in place. After the minute, Sue allowed the dilator to slip out, and, catching it before it fell to the bed, she dropped it into the receiver to be washed later. All the time, Julie was videoing the whole process.

Next Sue took a bladder washout pack and, after removing it from the sterile pack, placed it in a jug of warm water together with a thermometer for it to warm up to body temperature. She then took a soft red rubber catheter and connected it to the warmed saline. Opening the clip on the saline, she squeezed the saline into the catheter until all of the air was expelled, evidenced by a bead of saline appearing at the catheter eye. She lubricated a finger and smeared the gel around the catheter tip and then inserted her finger in Amy's rectum.

On removing her finger, the catheter tip was inserted to a depth of about four inches and the clip released from the saline pack. Holding the catheter in place with one hand, she held up the sachet of saline to allow it to drain into Amy's rectum, squeezing the last few drops out of the sachet. Quickly she clipped off the sachet and withdrew the catheter. Amy was well used to this as the nurses did this regularly for her.

Amy was assisted onto the bedpan to evacuate the saline washout, but the camera was turned off for that.

After that, the nurses removed their gloves and washed their hands. Taking new gloves each, Emma picked up a syringe and used it to suck out the sterile water inflating the balloon of the Foley catheter in Amy's bladder. With a gentle pull, the catheter slid out and Emma dropped it into a waiting receiver for disposal.

“That's all,, thank you,, Amy.” Sue said. “There's just one more thing. I'm going to slip an all-in-one incontinence brief on you just in case you leak a little on the way home. Is that all right?” “Amy agreed as Sue slipped the green plastic covered garment under her and drew the font up between her legs and over her abdomen. She fastened the hip tapes tightly to prevent leakage, but left the waist tapes slightly looser than usual to avoid squashing Amy's ileostomy pouch.

Amy stood up as the garment crackled alarmingly as she moved. Amy was helped into her normal clothes and driven home, with Sue's promise that she would see a copy of the DVD as soon as it was ready.

To her surprise, Amy found herself looking forward to that!