Section 1

As usual during the summer vacation the list of students for the next academic year's placements came through. As usual I ignored it until the Dean called for my nomination. I hate students: they get in the way, ask dumb questions and more importantly they stop me having fun with my patients. Not of course that my patients realise that I am having fun, they think that I am being thorough and taking good care of them. Not many think that the time I take with them is mainly for my benefit. My regular patients have got used to it, in fact I suspect that one or two positively enjoy it, but I know form experience that students will ask me why it takes so long to auscultate a young woman's chest, or why I find it necessary to order enemas for so many of my them when that's considered old-fashioned by today's medical standards.

So I am reluctant to take on a student but I have to. I usually look for one that's lazy, won't ask too many questions and isn't really interested in general medicine: budding surgeons and psychiatrists throw their stethoscopes away quite soon after graduating and take much less interest in my activities than some others.

I scan the list; it looks as though the likely candidates have been snapped up already, my fault for leaving it so long. Then a name catches my eye. Lia Chan. Unusual. I look closer at the details. Female - good. If I must have a student then I want a female one. Good academic grades. Hmm. Might be a bit keen then. But wait a moment - she's from the US on some sort of exchange programme. Now that is interesting because obviously we Brits practice medicine in an entirely different way from Americans. Not really of course but she probably won't know that. I scan her application. First time out of the US, so she definitely won't be familiar with our way of doing things. This looks better and better.

I ring the Dean and say I will take Lia. Luckily he agrees.

I get Lia's email address and draft an email to her:

Dear Lia,

Welcome to St. Hope's Hospital for your exchange programme. I will be looking after you for your stay with us. You will get the official welcome later but I just wanted to introduce myself to you and tell you what to expect.

I train general practitioners so see a wide variety of patients with a wide range of problems. In addition I do the requests for health insurance, employment medicals and so on. So you'll see and learn a lot I hope.

One of the requirements of joining St Hope's is the pre-employment medical, which I am required to carry out. I'd like to get that scheduled as soon as I can, and I see that you're arriving in the UK next Saturday. Perhaps you would attend my clinic on Monday morning at 9:00 am so that we can get that out of the way before your formal attachment starts.

You should expect it to last several hours as St Hope's requires a very thorough checkup for new students. St Hope's has high standards for its staff and students and you'll be expected to adhere to the hospital's dress code. This include being smart - no jeans or trainers; matching underwear - no G string or thongs; a smart business suit with a transparent shirt or blouse underneath. Stockings or bare legs are preferred over tights. Overall you will be neat, tidy and professional.

It would be a shame to have to issue a discipline notice on your first day so please make sure you read, understand, and practice this code at all times. If you have any questions then please contact me

I look forward to meeting you on Monday.

Doctor Brian

I hit the send button. Lia is not to know that apart from looking professional, the hospital's dress code says nothing about what she should wear - particularly about her underwear. That's what I like to see. and I will be seeing her underwear - all of it. But she'll think it's just the English way of doing things, quaintly old-fashioned. She also won't realise that the standard pre-employment medical is just completing a form, only seeing a doctor if necessary. I intend to be much more thorough than that, after all you can't be too careful.

Section 2

Dr. Brian's email is a bright spot on an otherwise grey morning. I sit at my desk, with a towel around my still-wet hair, reading the missive over for a third time and trying to predict what my new attending -- oh wait, in the UK they call them something else -- will have in store.

It's nice that he sent a personal message. The attendings on previous rotations didn't bother; they all just greeted me with clinical handshakes and quick once-overs on my first day. But since this will be such a big jump, it's a relief to know that I'm expected.

Talk of a pre-employment checkup doesn't faze me. Britain's an island so of course they're more careful about communicable diseases. However, the timing is arranged for his convenience and that's a pain. I'll still be jet-lagged on Monday so 9 a.m. will actually be 1 a.m. by my internal clock. And what's with this "several hours"? Is there an interview or paperwork involved? I can't imagine an ordinary physical taking that long, although maybe Dr. Brian subscribes to the idea that students can learn a lot by being on the receiving end of treatments. This would actually mean we have comparable philosophies which would be exciting and a big switch from my last rotation where the attending, a neurosurgeon with a mania for control, did everything in her power to stop me from actually doing anything myself.

The biggest hurdle of the entire message is actually St. Hope's dress code. Looking "smart" and professional makes perfect sense, but to specify what a student should wear down to her blouse and underwear? Dr. Brian must be really old-school. Then again, maybe he's just covering his bases -- telling me the hospital rules without expecting me to really adhere to them.

I unwind the towel and rub my damp hair, giving the screen a little smile. Obviously the UK has a few surprises waiting for me.

Still, it's not going to do me any harm to put on a good face. In fact the minute I read about the dress code, an outfit jumps to mind. I have a very nice DKNY skirt-suit, single breasted, in dove grey. I don't own anything approximating a sheer blouse, but there's a lavender summer top I can put on underneath. Together with flats, elastic-top stockings, and my premiere set of matching underwear (dusty rose, embellished with lace) I'll be professional, feminine, and put-together, thus convincing the British that we Americans can in fact do "smart" and do it very well, thank you very much.

Nodding to myself, I draft a quick reply to Dr. Brian, and then get up to organize and pack some more in order to further my plan of taking the island by storm.

Section 3

08:45 Monday morning

I arrive at St. Hope’s full of enthusiasm; there are days when I really, really enjoy my job and this is one of them. I walk through reception for my clinic, the reception staff is already there but I don’t see anybody else waiting yet. Let’s hope Lia is not going to be late for her appointment. Or rather, let’s hope she is, another reason for introducing her to the discipline code.

My surgery looks like any other, superficially. All the normal medical equipment is there. But the room is dominated by the patient’s couch. It’s slightly larger than normal and seems to fill the room. The obvious features are the stirrups, which I don’t hide at the side like so many doctors. I want my patients (both male and female) to see what they’ll be put into. I like them to be a little apprehensive. Less obvious are the fittings all along both sides of the couch that I don’t always use, but sometimes if a patient is being particularly difficult the steel rings and straps may have to be employed to allow me to complete the examination or treatment.

I pull a trolley out and start to put my instruments on it. I generally leave the trolley in full view of the patient – it all adds to the feeling of fear and apprehension. As well as the normal ones, a stethoscope, ophthalmoscope, sphygmomanometer and so on, the tray contains a number of other instruments that patients don’t normally see and might wonder what purpose they serve. The tray gives a satisfying “clunk” as I set it on top of the trolley.

A few minutes to 9. I review Lia’s file. There’s no hint in as to how she will react to this examination but I am confident that she will accept it, as so many have done before. I ring through to reception to ask them to send Lia through. As normal the staff will instruct her to come up to my room and knock on the door and wait.

Luckily Lia is not late. She reported to reception and was told to wait until the doctor was ready. The chairs were uncomfortable – they always are in clinics. There was nothing to read so inevitably her thoughts turned to the coming examination. Although used to examining, she always felt a little apprehensive when she was the patient. She squirmed around on the chair until finally the receptionist called her over.

“Doctor Brian is ready for you now. Down the corridor, last door on the left, room 101. Good luck, and make sure you don’t upset him” is the receptionist’s instruction. As she walks down the corridor looking for the correct number, she doesn’t notice that her skirt had become a little skewed from her fidgeting on the chair. At last, Room 101. As instructed, she knocks and waits.

I hear the knock, but it is bit timid, so I decide to ignore it. I wonder how long she’ll wait before knocking again. A few moments later she does. Much louder and more confident this time, so I call “Enter”.

“Close the door and come in” I instruct. Lia complies and stands in front of me, her eyes roaming round the room, taking in the environment. I see her startled by the couch, her eyes keep returning to it as if she can’t quite believe it. She also looks long and hard at the instrument tray while pretending that she isn’t.

I observe that her skirt is not straight. That seems to be the only problem with her clothes, although of courseI have not yet had the opportunity to check her underwear. I do notice that the blouse is not transparent which is a shame. Time to stamp my authority on this session.

“Did you check that your clothes were on properly this morning?”I ask pointing to the rucked skirt.

“Oh, sorry” she mumbles, obviously not expecting this to be her first conversation with me.

“Sorry, what?” I remind her. “Sorry, Doctor” she replies.

“Put it straight, and then turn round slowly” I tell her. As she does, I can see that she has some nice curves. This is indeed going to be a good day.

I instruct her to sit down in front of my desk. Just to the side is the couch and instrument tray, just sight if she glances to the side.

“You’re here for your pre-employment physical,” I continue. “As you are from the U.S., I need to complete a through examination, to satisfy government health regulations. I expect you to cooperate at all stages with me, otherwiseI may have to take other actions.”

The government health regulations are a complete fiction of course, that is just an excuse for what is to come.

“Now I need to take your medical history; I expect you be frank and truthful.” The medical history starts off straightforwardly.

"Any current illnesses or complaints?

"On any medication, including the contraceptive pill?

"Family history of heart disease, diabetes?

"History of inoculations: tetanus, polio, TB, MMR?

"Any known sight/ hearing problems?

"Smoking & drinking habits?

"Blood pressure problems?

"Height & weight?

"History of depression or other mental illnesses?

"Any other medical problems the hospital needs to be aware of?"

Then some rather more personal questions. None of them needed of course for the employment but to complete my file, I have found it helpful to understand my students’ lifestyle.

"Bra size?

"Sexual orientation?

"Do you have a current partner?

"Are you a virgin?

"When did you last have sex?

"Describe that occas Ion.

"Favourite sexual position?

"How often do you have sex?

"Describe your sexual fantas Ies.

"Describe how you masturbate.

"Do you use any sex toys regularly?"

It is amazing how many of my patients, with a little prompting, will admit to all sorts of sexual practices. I do so enjoy hearing their descriptions, which I try to get in as much detail as possible. I make notes, of course, for my private files as Lia starts to answer the questions, obviously embarrassed.

“You’ve said you’re not a virgin so surely you can remember the last time you had sex? Last night? Last week? Last year?”I say with some impatience as she hesitates; she finally manages to stutter the answers out, giving me a full picture of her sexual life and interests. This is going to be an interesting sessionI think.

“I am now going to start the physical examination – please take off your jacket and sit on the side of the couch,” I instructed. As Lia compliesI can see that the lavender coloured top is not quite what I asked. Never mind I’ll deal with that later. Let the games begin.

As Lia sits I can see her surreptitiously glancing toward the instrument tray, still unsure of what is to come particularly in the light of that very personal history-taking, the likes of which she had probably never encountered before.

Section 4

Nothing about Dr. Brian is what I expect.

First off is his demeanor. Right from the get-go he's brusque, even stern, treating me like a first-year or a lazy RN instead of somebody who's crossed a continent and an ocean to come work with him. There is no no greeting. No handshake. The minute I walk in he's criticizing, giving orders.

"Did you check that your clothes were on properly this morning?"

I look down, aghast. My skirt has somehow worked its way around so that one of the seams has crept forward. Hurriedly, I adjust it, mumbling apologies, and then forgetting his title, digging myself in deeper.

Fabulous, I think. So much for first impressions.

The second thing I notice about Dr. Brian is his appearance. Despite his age, he's a solid eight or maybe even a nine on my scale, with a firmness about the jaw and a steady, deep gaze that together stir up more things inside me than a full-body MRI. It takes me a full two seconds of sleep-deprived, floaty time before I realize I've been staring. Crap. That was probably five seconds in his world.

C'mon, Lia, I chide myself. Snap out of it!

ButI can't stop staring. Not just at him but at the whole room. The exam table is huge with the stirrups just out there for everybody to see instead of tucked decently away like on other exam table I've ever seen. And those fastenings on the sides -- are those points to attach restraints? Yikes. But maybe in a country where the maxim is "Keep Calm and Carry On", nobody is fazed by any of this.

The instrument tray is next to get my attention. I don't want to seem nosy, especially after my earlier gaffe, but I've already caught a glimpse of more than one tool that I don't usually see, so both my professional and personal curiosities are fired up and ready for the green light.

Before long Dr. Brian is directing me towards a desk where he sits across from me, and starts taking a history. Something familiar -- thank God. It's easy to tell him I feel fine and am not taking any meds, with up-to-date inoculations, and no family histories of serious ailments except for some asthma on my father's side. It's a little harder to do the metric conversion in my head, butI get out 160 cm and 52 kg without too much trouble.

However, the next question floors me.

"Bra size?"

"32-B" I blurt before realizing they might measure band sizes in centimeters too. I really have no idea.

"Sexual orientation?"

I stare at him. He's looking down at his papers as if the question were perfectly normal.

"I'm bisexual."

"Do you have a current partner?"

What an idiotic question. What -- was I supposed to have picked somebody up between here and Heathrow, on my day and a half in the country? Still, he's looking up at me inquiringly now and I know he expects an answer. The belated realization that I could have been humping like a bunny prior to my departure and that the question may in fact be medically relevant makes my cheeks go red. So I give him a timid "no" and then an even quieter negative when he asks about whether I'm a virgin. For some reason, it calls to mind a bizarre image of me tied to an altar before an audience of swaying natives. He's a shaman in beads and leather, parting my legs so that I can be ritually deflowered, slamming up into me to the sound of great acclaim.

U.S. practitioners would have asked "Are you sexually active?" and would have put that question first.

So no. I'm definitely not a virgin. But my detour into fantasyland made me miss something. "I'm sorry, could you repeat -?"

"When did you last have sex?"

With you, in my head, two seconds ago. I feel like saying, but hold back for obvious reasons.

"Umm, maybe about two months ago?" It was definitely before that last surgery rotation, notorious for leaving time for nothing but work and disconnected shreds of sleep.

"Describe your sexual fantasies."

There is nothing to stop both of my eyebrows from practically disappearing into my hairline. Oh my God -- did I just give some indication that -- No. There was no way he could have guessed. Then my brows come together. What the hell? That is a totally inappropriate question and he knows it.

But then I see his expression -- his calm, calculating gaze -- and I know that not only does he expect a complete and honest answer, but he's got my number. Did I just give something away? Can he somehow sense way my PC muscles are giving the odd, involuntary twitch as I drink in his eyes, and his voice, and his practised hands, as I imagine how they might assess me, probe me, and claim me as his?

When he clears his throat, I almost jump.

"Uh, the usual stuff, you know. Candle-lit dinners. Walks on the beach." I give a cute little smile. He doesn't take it well. There is no outward change in his expression, but somehow I just know that doesn't appreciate my lame attempt at dodging his question.

But dammit, what am I supposed to say? That he's suddenly starring in every depraved fantasy I've ever had? That I'm even now imagining myself as his test subject for a study in orgasmic endurance with complete exposure, of course, and a witness or three? Or him evaluating my gag reflex the old fashioned way, while I'm hooked up to digital thermometers, EKG, EEG, the works, with video and data streaming live to a thousand terminals via the web? Him in a hazmat suit, scrubbing me down in some subterranean lair and testing for evidence of contamination as all my rights are suspended? Or having him whisk me away to some idyllic little English cottage, complete with his own surgery, where he'd gently and expertly mould my body and mind into those of his ideal, with corseting, hormone therapy, and treatments of my vaginal and anal muscles so that they could ripple up and down on him during his frequent and prolonged penetrations?

Admitting any of that is completely out of the question.

"Describe how you masturbate."

Oh crapohcrap, I am definitely in for it now. He so has my number. Lia Chan, poised for years between a raging medical fetish and an attempt to actually have a career in the field. The only question is, when did he figure this out? Just now, when I came in? Or earlier? And if so, was it before he'd accepted me as his student, or after? Did he find something on the web? Did one of my previous partners talk too much?

But despite all my fears and mental scrambling, I find myself excited beyond belief. Nothing has ever been this close to the surface before. And having everything so openly acknowledged is turning me into a giddy bundle of anticipation.

"With my . . . fingers. A vibrator now and then." Oh and, you know, anal plugs. Little rubber rings on my nipples. A really lovely anesthesia mask across my nose and mouth, with the hose snaking down towards my privates so I can breathe in the scent of my own arousal as I work myself, toes digging into the mattress, head thrown to the side, eyes closed, thighs spread and quivering.

"Do you use any sex toys regularly?"

I freeze in my chair. Oh my God, is he a mind-reader? I'm caught between embarrassment and arousal, cheeks flushed and maybe my upper chest as well. Panties more than a little wet now, and with my tunnel clenching almost rhythmically. And if he's this thorough with his questions, what is the actual exam going to be like?

"The, uh, vibrator, likeI said." I'm so turned on I'm lightheaded.

When he has me step over to the exam table, something he calls a couch, I check between the open panels of his lab coat for obvious signs of arousal. But there's nothing, in fact aside from the wording of his questions, he's been coolly professional the whole time. So I close my eyes for longer than a blink, breathing deeply, trying to regain some semblance of composure. The fact that he's maintaining such excellent control is sending me even higher. All thoughts of ethics and decorum are out the window. AllI want is for him to use everything on that tray and then some. To assess and appraise me. To find me hot, and worthy, and good.

Section 5

I guess that doctors, like police officers, get a sixth sense about the people they deal with. I just know that Lia is giving me deliberately vague answers on her sexual history. Candlelit dinners? Walks on the beach? I wasn't born yesterday and that just doesn't ring true. Her posture and facial reactions during those questions indicate that there is more there, something deeper. But I don't think this is the time to probe; she will reveal her most secret thoughts to me in good time.

Meanwhile, sitting on the edge of the couch, I take my time appraising her - not just for any obvious signs and symptoms, but also noting her slightly flushed appearance. Her skirt rides up as she gets onto the couch but, as that gives me a glimpse of stocking top and the delights yet to come, I am prepared to overlook that for the time being.

ButI do have an issue to address.

"I believe you were told that you had to address me as 'Doctor' at all times" I state. "You have not been doing so and I would appreciate that courtesy for the rest of this examination." I let the implied threat hang in the air.

I stand in front of her, and gently massage the soft tissues around her throat. "Swallow" I instruct several times. I find it good to get some hands-on contact with the patient early on. I move round the other side of the couch and repeat it. She seems to have some difficulty in swallowing but I don't believe that has a physical cause.

I return to the front, and pick up my otoscope. I tilt her head to one side, no point in wasting time asking the patient to, they just get it in the wrong place. I insert the instrument; apart from a little wax everything looks OK. I repeat the other side. I scribble on my pad and return to the instrument tray. What next? Normally I do my examinations strictly top to bottom but sometimes there's a reason to alter. But on balance, carry on.

I pick up my flashlight and check her pupil reactions. Then I change to the opthalmoscope and dim the room's lights.

"Look straight ahead" I instruct. I set the lens to its initial setting and move in close to her face, so close I can smell her perfume quite strongly. Not quite to my taste, but certainly not unpleasant. I also take the opportunity just to rest my free hand on her shoulder, feeling surreptitiously for her bra strap. I can't quite find it, and switch across to the other eye with more success. Obviously her right hand strap has fallen off her shoulder. Bad news.

There seems to be no problems with here eyes, and a check of her visual field and accommodation confirms that. With lights back up to full power it's time to move on.

"Open you mouth - wide". Lia half-heartedly obeys. "Wider" I instruct, noting that this was another occasion when she has failed to obey my instructions properly.

With her mouth wide open, I get my flashlight and tongue depressor and examine her mouth and throat. No apparent problems. But as I remove the wooden stick, she starts to close her mouth. Oh no -- not after failing to open it properly in the first place.

"Keep your mouth wide open, I haven't finished yet". Lia starts to protest that she's still tired and suffering from jet lag. I cut her short: answering back is definitely not on. I note that on my form.

"Well if you are too tired to keep your mouth open, I'll keep it open for you". I snap on some latex gloves, and I reached over to my tray and pick up what is probably one of the less well-known instruments. I slip the dental gag into her mouth and adjust it so that her mouth is forced wide open. Although not a dentist, I have a good collection of dental instruments - including the gag. I pick up the dental mirror and probe and as I move towards LiaI see something in her eyes. I am not sure if it's fear or excitement at the prospect of having her mouth and teeth probed while she can't move her jaws.

It's quite easy to find some excess food or plaque on teeth, you don't normally have to look very far, and sure thing my survey finds a bit of food remnant between two teeth.

"Hmm" I said, showing Lia the detritus. "This is not good enough for a clean, smart professional. Make sure you clean and floss before coming on duty". I continued to work my round her mouth, Lia flinching occasionally as some sensitive part of a tooth was touched. I prolong the dental exam, as I want to punish Lia for her earlier mistake. The gag, while not uncomfortable, does make a patient's jaw ache after a time.

Finally I loosen the gag and remove it. Lia works her jaw to restore the circulation but I swear I see a small smile of delight flit across her face. PerhapsI am getting a little nearer to understanding her.

"Take your top off" I instruct. Lia looks round for somewhere to go to undress - a screen or something. I don't have one. Patients are required to undress in front of me.

"Hurry up, just get your top off. You can leave your bra on," I repeat. Somewhat shyly, the lavender blouse comes off. I pretend to be looking at my notes, but really my eyes are on the strip tease taking place in front of me. She undoes the buttons one at time, slowly - deliberately so, I feel - before slipping her arms out and hanging the blouse on the hook by the couch. She stands in front of me, arms by her sides, beginning to look exposed and vulnerable.

I notice that indeed her right-hand bra strap is twisted and off her shoulder. I point this out as yet another example of lack of attention to detail and mention that such slips will not be allowed in future. However the bra itself is very fine, and pleasing to see with its touch of lace around her breasts. Her mammae themselves look full and round - bigger than a 32B, I think. That will be something else to check in time.

"Sit back down on the couch" I instruct as I reach for my stethoscope.