Head to Toe Assessment

All people depicted in this story are over 18 years of age and completely fictitious.

*

"Yes, it is registered as Northern Manitoba Mobile Medical, we have an application pending." I said.

"Oh yes, I see it here. Let me have a look," said the agent on the other end of the line.

"So it looks like everything is in order pending your physical examinations."

"What? I thought since you guys were taking over from the old guys that our existing files would just carry over?" I said.

"Sorry, no, we found that many of the old accounts in your region had serious time lapses in their medical histories, so the executives insist on the medicals before acceptance into our plan."

"The reason there are lapses in our region is because we are a remote, fly-in community with no Doctors," I pleaded. "The only reason I have a job up here is because I am the closest thing these people have to a Doctor!"

"Yeah, sorry," she said. "It says that applicants are required to complete an acceptable comprehensive medical assessment."

"Hold on," I said,"a comprehensive medical assessment is not the same as a physical examination."

"Huh?" she said.

"You could be costing your company clients by using the wrong terms. A comprehensive medical assessment can be performed by a Registered Nurse, like me," I emphasized. "A physical examination needs to be signed off by a Doctor."

"Oh, sorry," she said.

"Wow," I said shaking my head at the phone receiver.

"Okay, I guess I can't sign my own assessment, but I'll get my business partner to fill out the form and I'll get them to you when I can," I said.

"That would be great," she said.

I knew nothing I told her had really sunk in. "Okay then, bye I guess," and I hung up the phone.

I sent Maggie a text to let her know we had some forms to sign. She rang me back almost immediately.

"Forms eh? Can they wait? I am bouncing around the islands doing my rounds next week," she said.

"I'm afraid not, the new insurance company requires 'head-to-toes' from us before they renew, and we expire on Wednesday," I said.

"Head-to-toes eh?" she said with a sing-songy tone "Oooh, you should at least take me out to dinner before you get me naked," she joked.

"Ha ha!" I laughed. "Just pop by and sign my form, I'll sign yours and you can enjoy your weekend before hitting the road next week."

"Oh, you're no fun," she teased. "Seriously though, fellow nurse or not, I won't sign off on anybody's medical status without doing the assessment myself."

I sighed, but I knew she was right, and I knew I would feel dirty about signing her form without an exam.

"Yeah okay," I said. "You want to get this over with tonight?"

"Sure, I need a shower though, so why don't you come to my place. My sister will be home but she won't be a problem. She wants to meet you anyway," Maggie said.

"Okay, I'll bring the forms over after work, and I'll bring the van so we'll have all we'll need." I said.

"Don't forget to scrub your balls for me!" she said before laughing and hanging up. "Jesus Maggie," I laughed.

Maggie and I had both answered the call when a plea went out from the Provincial Government for medical workers in the North. As registered nurses, we set up competing practices in Churchill, a town of around 900 people. We quickly realized that Churchill wasn't big enough for the both of us. The real need was travelling around the small Northern Reservations and communities, performing medical services as we went. This mostly consisted of flu shot clinics and performing basic diagnostics and treatments with what little equipment we could carry with us. We both ended up spending too much time away from home, and found this type of practice exhausting.

After two years of this, Maggie and I decided to partner up. We bought a cargo van that we combined our resources to fully equip, and took turns hitting the road in it. We carved up the map of our region and scheduled accordingly. She'd take the van off on a route for two to three weeks and I'd do the same when she returned. There wasn't a lot of overlap, so we didn't see much of each other, which was a shame because I enjoyed her company. Phone service on the road up here is non-existent, so we basically just texted each other most of the time.

It turned out to be a good business model, and we were able to provide care to as many patients as possible without stretching ourselves too thin. Other than helicopter emergency paramedics, we were the face of medical services for this part of the province. The closest Doctor was 500Km away.

I left my car at the storage locker of supplies that Maggie and I maintain. I took the medical van home with me, had a quick bite to eat and a shower before heading over to her house. Maggie lived on the water and had a really neat vantage point for watching the beluga whales when they were in the harbour. When she didn't answer her door bell, I walked around back to find her and her sister sipping wine and looking out over the water. In Churchill there is no 'patio-season'. The Northern chill off of Hudson's Bay, never warms it up enough to enjoy those warm summer nights I grew up on in Southern Ontario.

"Oh hey Butt Scratcher!" she called out when she saw me come through her yard fence. "Just trying to spot any pods out there, but the waters too choppy" she said.

"Livy here is going home next week and she really wants to see a Beluga before she leaves. I told her she has to come back in the winter to see a polar bear."

Maggie was wearing a tight knit sweater over black yoga pants that really showed off her curves. Her wavy brown hair which was usually either in a bun or a ponytail was let loose and fell nicely on her shoulders. She looked quite different from the scrub wearer I was used to seeing.

"Hi Livy, nice to meet you," I said.

"Nice to meet you Butt Scratcher!" she said and they both burst out laughing. I got the feeling this wasn't their first glass of wine.

"Why does she call you that?" Livy asked.

"Oh man, she caught me playing a video game online with my friends one time and heard them use my old nickname. Of course, she won't let it go," I explained. "Ben Sacher to Butt Scratcher is the real origin story."

"Well Ben, it is nice to finally meet you, I have heard soooo much about you." Livy said.

"Oh stop," Maggie told her. "Come on, it's cold outside and your pie should be cooled off enough by now to cut into."

We headed into Maggie's through the back patio door which lead into her kitchen. Maggie served me a piece of pie without asking if I wanted any. It was delicious, so I had no regrets. The two women sat across from me, staring at me as I ate as if they had something to tell me.

"What? What is it?" I asked.

"Well," Maggie said. "As you know, Livy is off school visiting me while at the same time studying for her semester finals."

"Right," I said. "Nursing school Mags tells me. Good for you!"

"Yes," Maggie interrupted, returning to her point. "One of the exams she is going back to be tested on is the Physical Examination."

"Oh boy, I bet I know where this is going," I said.

"Well, I thought if she did our assessments we could oversee and guide her through them while at the same time we could witness and sign off on each others insurance forms. She'd get a chance to perform the male and female head-to-toes. I know that would have been helpful to me when I was at school," she said in a hopeful tone and handing me a glass of wine.

I looked at both of them hesitantly, "Why not," I said to their applause after some consideration. "A heads up would have been nice though Mags," I said.

"Then we wouldn't have seen you squirm," she laughed.

"Okay, let's get this over with," I said.

Maggie and I went out to the van for the necessary supplies. When we came back in, Livy had closed the curtains in the living room, put on a pair of Maggie's old scrubs and had her textbook open to the Physical Examination Checklist page. We had a heavy duty, folding table that we could lie patients down on. Maggie gave it a quick wipe down, as it had been in the van for a while.

"No gowns to wear, so I guess just underwear?" Livy stated in a questioning way.

"That's fine," Maggie said.

"Who wants to go first?" Livy asked.

"I thought this would be less awkward for all of us if we both went at the same time." Maggie said. "Just go through the checklist step by step on each of us," she added.

"Oh, yeah I guess that makes sense," Livy agreed.

Maggie and I both just stood there waiting on each other or waiting for Livy to direct us. We locked eyes and grinned a mutually embarrassing grin and started stripping down. I slipped off my shoes and socks and set them under the table. I stood up and started unbuttoning my shirt, taking a quick peak over at Maggie. She had her back to me as she was peeling her sweater over her head. Her beautiful curls fell back over her creamy shoulders and black bra straps. I noticed the top of a tattoo sticking out of her yoga pants on her left side, in the curve of her torso. It was a Native style polar bear. "She is a true Northern Girl," I thought to myself.

I removed my shirt and pants quickly, leaving me in a t-shit and boxers. Maggie was struggling a little trying to wiggling out of her tights. "This is why you give patients some privacy when they are changing," she said. "When people know they are being watched they get clumsy and nervous."

"Yeah, not exactly as smooth as a pole dancer," Livy said. We all laughed a little.

Maggie was down to her bra and panties. A practical set, nothing too revealing. She was in great shape and had a really nice body, toned and well proportioned where she should be, curvy and soft where she would want to be.

I gave my head a quick shake. I am used to seeing patients in their homes, so this wasn't exactly out-of-the-norm for me. I just wasn't used to seeing Maggie like this. Maybe it was the wine, or the fact that I was half-naked in front of two women myself. Whatever it was, something was interrupting the 'professional' alter ego I usually engage when I am with patients. I could feel my heart rate was slightly elevated and the blood was reaching my extremities. "Whoa boy," I thought to myself, folding my clothes and trying to occupy my mind on something other than 'half-naked Maggie.' We both leaned our butts against the table, standing well apart from each other awaiting instruction. This was definitely awkward. Maggie was going to owe me big time for this.

"So I have a checklist that I'd like to follow," Livy said. "If I am thorough, and check everything, I can skip the personal questions that would identify areas that I should check. Might be less awkward for you guys considering you are friends and may not want to share everything with each other,"

"That makes sense," I said.

"Yeah," Maggie said hesitantly. "As long as you are not too shy to ask the questions when you need to. It might be good practice to just go ahead and ask us them."

"I'll ask some of them as I go then," Livy said. "I'll try not to get too personal."

"This assessment is as personal as it gets," I said. "You want to respect privacy, but you need honest answers from your patients in order to best help them."

"Got it!" Livy said, looking nervous, but excited to get started. "Okay, let's start with vitals!" she said.

She grabbed the blood pressure cuff and wrapped it around my left arm, inflating it, deflating it, listening. Without a word she did it a second time. "125 over 84" she said.

"A little elevated for me. Guess that's the wine and the awkwardness," I said with a smile.

Livy moved over to Maggie. From my viewpoint, watching the cuff slip over Maggie's left arm meant looking right across her chest. "Man," I thought. "Scrubs really do a disservice to the world."

Livy checked Maggie's heart rate. She forgot to check mine but I didn't mention it. It was obvious she was a little nervous. She told us she would skip taking our temperatures, since that was easy.

Maggie interrupted, "Hold on, It is not always easy and not always straight forward. For example, how would you check on a baby?" she quizzed.

"In the ear until the age of 2, under the arm or in the mouth for adults!" she answered quickly.

"And the most accurate method?" asked Maggie.

"Rectal," she said. "But I won't put you through that."

"Okay, you're doing great. Keep going," she said walking over to the thermostat to warm the room up a little, which I appreciated.

She came to me next, taking a quick look in my eyes, mouth, and ears. She parted my hair in a few places to check my scalp. She then started checking the glands in my neck and jaw. She paused and looked over at Maggie. "To be honest, I'm not sure what I am feeling for here."

Maggie got up and stood before me with Livy moving to the side. "For starters, you shouldn't have to reach up to your patient like this. You should have had him sit for this part." I took the cue and parked my butt on the table, bringing my eyes directly in-line with Maggie's chest. She gently felt my glands explaining the size and texture that should be expected. Livy took over, checking me again. She then had Maggie sit down and checked her glands for comparison.

"Okay, off with the shirt, I guess," she said coming back to me.

I pulled off my t-shirt and caught Maggie giving me a quick once over with her eyes. "You both are in great shape," Livy said. "Are you getting lots of exercise and eating your fruits and veggies?"

"Good approach," Maggie said encouragingly. "I run at least three mornings a week. I eat well when I am home, not so much when I am on the road."

"Yeah, it's tougher on the road," I agreed. "I have an exercise bike for cardio and I do regular pushups and sit-ups," I added.

"It shows," said Livy tracing my spine from behind. She did the same for Maggie before returning to her checklist.

"Okay, lie in prone please," she said to me.

Maggie hopped off the table and stood over me to my left while Livy took a position on my right. I laid down and gave my crotch a quick adjustment. My boxers were baggie and had an open flap fly that could be revealing if I wasn't careful. Livy lifted my arms, checking more glands. She pointed out a skin tag to Maggie, who said it was nothing unless it bothered the patient. She palpated my abdomen, a little too gently. Maggie took over and showed her the proper technique. She checked under my arms as well. She wasn't going to sign my form without checking everything herself. Livy's pokes reached just above my waistband, when Maggie stopped her. "Ah-ah," she said, taking her sisters fingers and pushing them a couple of inches under the waistband to the proper location. "You have to do this right if you are going to do it," she said. Livy removed her fingers and Maggie quickly slipped hers in for a check, looking into my eyes at the same time. "Thanks for doing this," she whispered with a smile.

"Oh, you owe me one," I whispered back.

"Okay switch positions," Livy said.

I gave Maggie a quick gland check and felt her abdomen with my usual routine. Livy took over and did the same. She was a lot less hesitant with Maggie than she had been with me. I remembered it being a little awkward when I first had female patients.

"I have to do a breast exam," she said.

"Yes, you do," said Maggie, who, without hesitation lifted herself off the table, unhooked and removed her bra in one swift motion. "Do you want me sitting up or lying down? Either method is acceptable now," she said.

"Sitting up I guess would feel the most normal to me, since that is how I practice on myself," said Livy.

Maggie sat up and looked at me with a shrug, as if to say, "this is me".

"Best boobs in the family," said Livy laughing.

She stood directly in front of Maggie and mumbled notes to herself, "Even size, shape, no discolouration. Okay, raise your arms straight above your head," she directed. Maggie complied, looking at me with the shy look of all women that are exposed at this point in the exam.

"Okay, they look good," said Livy.

"Yep!" I agreed.

Livy stood behind Maggie and reached around, positioning her fingers on Maggie's right breast. She made small circular motions following a pattern across her entire breast before switching to the left one and repeating.

This was very clinical and I had performed it a thousand times, but watching it being performed in front of me was different. When I was performing a breast exam I was concentrating, trying to be as quick and thorough as I could be for the patients sake. Watching it done though, it was hard not to see it as Maggie getting her breasts massaged. I again felt some stirring in my boxers and tried to get a grip on myself and be professional.

"I don't feel any abnormalities," said Livy.

"Great," said Maggie. "I have chaperoned Ben when he has done a few of these, so I know he prefers to do them with the patient lying down. Ben, you have to check me anyway, so you might as well demonstrate."

Maggie lay down in front of me, her brown hair pooling behind her head with her perky breasts awaiting my touch.

"Sure," I said. "I do the visuals as you did, with the patient sitting up," I explained to Livy. "Then with her prone, I start the circular pattern from left to right. I then reach across so I can use the same exact pattern and with the same fingers on the left breast. I am dominantly right handed, so I am a little awkward with the reach-around move on the left side," I said.

I snapped into nurse mode and started my routine, first on the right breast and then on the left one. When I wasn't a bystander, I was able to focus on my task as if Maggie was just another patient.

"Very professional," Maggie said. "It's important when touching intimate areas that your actions are deliberate and that you don't linger or feel around more than you have to. Nobody wants to feel like they have just been groped."

"Right," said Livy.

Maggie sat up and slipped her bra back on. I watched her breasts slip into the cups with a little disappointment. "At least this should help keep my boxers from tenting out," I thought to myself.

I sat back on the table and Maggie hopped up and joined me. She was sitting quite a bit closer to me than she had been the first time. Livy took a look at our feet, checked between our toes, did the reflex tap thing. She pointed out a mole on Maggie's calf that she thought should be kept an eye on. I took a quick glance and shook my head towards Maggie, letting her know it was nothing to worry about without sharing my second opinion in front of Livy. Maggie gave a knowing smile.

"Okay," Livy said, building up to something. "Time for the awkwardness. Who's first?"

Knowing exactly what was to come next, I quickly raised my finger to my nose, "not it," I said.

Maggie laughed, "real mature!" she said.

I cleared myself off the table and got all three of us a pair of disposable gloves. With her back turned to me, Maggie slinked herself out of her panties, tossing them onto a chair. "She has a great butt too," I thought to myself. She got back up on the table and laid down, crossing her legs and folding her hands on her lap. She was clearly a little bit bashful.

"Nice Tat," I said getting a better look at her ink.

"Keith's idea of a Birthday present," she said, referring to her boyfriend. "I never wanted a tattoo growing up, but I have gotten used to it and now I kinda like it."

"Keith," Livy said, with some disdain while gloving up. "Glad, he's out of the picture."

"Out of the picture," I thought. That was news to me. I knew Maggie and 'Hardware Store Keith' weren't serious, but I didn't know he was out of the picture.

"Yeah," said Maggie. "At least I got a free tattoo out of him!"