Being a pediatrician is a wonderful thing. I love my job so very much that saying it is a duty would be blasphemous. I love boys, and knowing that I have the knowledge to make them feel better when they are sick is a real blessing. To see them when they feel better, smiling wide, and ready to run outside in the grass is precious.
The majority of the boys I see, however, come in my office with a frightened look on their faces. Just like when going to the dentist, most boys are scared of going to the doctor. It is my duty, as a health professional, to reassure them that everything is going to be just fine. When they have to undress in front of me, for my examination, they are very vulnerable, and I have to make sure they do not yield to panic.
However, I have a little secret, or a big secret, come to think of it. No one knows about it. I very much enjoy inflicting discomfort and even pain to my little patients. Indeed, my heart starts beating furiously, and I have to remain calm when a boy undresses in front of me.
I always smile to myself when I see a little boy wearing long pants or jeans, along with a large sweater, probably thinking he is safe from exposing himself to me, but when the dreaded words reach his ears, to remove all of his clothes, the feeling of comfort vanishes instantly from his mind.
A lot of the boys I see, shake with fear when they are lying on the table completely naked on their backs, but the trembling usually ceases instantly as soon as my gloved hands touch their skin.
A word about gloves: it seems that the mere sound of snapping on latex gloves is a very powerful one. It startles all the boys whenever I put on a pair.
As you would imagine, I never really have a problem taking their vitals, even if they are naked. That part of the exam is done quickly. However, there is one part of the pre-exam that no boy enjoys: the temperature taking. Of course, other pediatricians would take a boy’s temperature orally, under their armpit or their ear; but I do not believe in these methods. The most accurate way to obtain a boy’s temperature is rectal. Now, you have to know that I use a special kind of rectal thermometer. Unlike the small glass rod, the instrument I use is seven inches long and has a diameter of one inch. No matter the age of the boy, I use this thermometer, and I insert it at least five inches deep, for optimal reading. I am sure you can now see why the little ones do not like that part of the vitals check.
I now have to tell you about one of my favorite parts of a boy’s physical exam: the digital rectal exam (DRE). With one gloved hand, using my thumb, index, and middle finger, I part the boy’s cheeks open to free the anus. Then, with my other hand, I insert two lubricated fingers as far as possible in the rectum. Because of the boy’s young age, the anal sphincter is extraordinarily tight, and the rectum can barely accept my fingers. The incredible tightness causes exquisite warmth to reach into my fingers. Of course, with younger boys, the digital rectal exam has to be performed slowly. Again, no matter the boy’s age, two digits have to be inserted. The procedure can be painful for them, but it is necessary to assess possible constipation as well as the tonicity of the anal sphincter.
During the DRE, some boys cry and protest. Some others, however, cannot keep still. In those cases, I need to restrain them. Of course, I could restrict them in non-humiliating positions, but I never do. My favorite position used to control a boy is while they are on their back on the examination table. Using Velcro restraints around their ankles, their legs are then brought up perpendicularly to their body with the help of a pulley on the ceiling. Another set of restrains is used for their wrists, and a final strap is brought across their abdomen to ensure complete immobility. I then make sure to leave them in that position for five minutes before I proceed with DRE.
During an examination, I always want to make sure to perform a comprehensive rectal exam. When the DRE is done, I proceed with a first visual exam of the rectum, using an anoscope, which is rather short in length (about five inches long). It nevertheless has to be inserted all the way in. When properly in place, I open its jaws to stretch the rectal walls and the anus. With a bright light pointed in the little one’s stretched cavity, I can see if something looks abnormal or not. I must admit that even after the visual exam is done, I leave the anoscope open and in place for a few minutes while I work on the patient’s chart. From time to time, my gaze would inevitably fall on the unfortunate boy.
Often, to complement the necessary visual exam, I perform an in-depth examination with an anal probe. Now, this is something that my little patients absolutely hate as well. The anal probe, on the youngest patients, can be very uncomfortable. I must say that this part of the exam is one I very much take delight in. The anal probe is a flexible instrument that is thirty inches long with a diameter of an inch. For the probe to be useful, it has to be inserted in its entirety in the boy’s intestines through his rectum. The insertion is followed on a digital screen to help guide the probe through the intestinal curves. So you can imagine the discomfort of the little one when such a snake is inserted inside him! He can feel it quite distinctly moving up his tummy.
Once, I had to use the probe three times on a six-year-old boy in the course of a week. He was terrified, screaming his lungs out when his father brought him to my office for the examination.
Of course, to perform all these examinations, the boys must have a clean rectum and colon. To achieve this, I give several enemas for each one of them. Since they are only boys, I exclusively use a double Bardex enema nozzle when I perform an enema. The two balloons of the nozzle are perfect for forcing them to hold the solution without causing any leakage. No matter the boy’s age, I never have a hard time inserting the first deflated balloon. Where the fun begins, however, is when I inflate that first balloon. First, the little boy is startled that something is growing inside his tiny rectum, but soon after, discomfort replaces the fear as the balloon expands more and more.
To complete the tableau, I inflate the second balloon, the one pressing outside, against his anus. The sight of the second inflated balloon, naturally parting the patient’s cheeks obscenely, is of absolute beauty. Sometimes, before I connect the Bardex nozzle to the rest of the enema apparatus, I make the boy stand by the exam table, his back to me so that I can admire his invaded bottom. Of course, this is purely for my sadistic pleasure. Thanks to the Bardex nozzle, I make my little patients hold their enemas for long periods.
I remember giving a nine-year-old boy a full three-quart enema bag that he held for an impressive forty minutes. The unfortunate thing had to be restrained, of course, as he would never have stayed in place.
On an older boy of twelve, I managed to make him hold a four-quart soapy enema for forty-five minutes, telling him that it was an absolutely mandatory procedure. After twenty minutes, I could even hear the gurgling of the cramps he had started to get. I did not restrain the boy, but he was crying a great deal without screaming.
The youngest patient I had to give an enema was a four-year-old boy. It was only two bulbs of a special mix of mineral oil to relieve him from constipation. He was the only one on which I did not use the Bardex nozzle. Instead, I used a small butt plug.
Oh, but I have not looked at the time. I have to get prepared because I have a patient in fifteen minutes! An adorable ten-year-old boy, whom I have seen three times already this past month, is one of my favorite patients for sure, and he probably is the patient with the utmost rectal reluctance. The mere spreading of his cheeks without touching his anus is enough to make him shake and cry. I think I will have to start his examination with a three-finger DRE, or perhaps four.