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 children 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 children I see, however, always come in my office with an afraid look on their faces. Just like when going to the dentist, most children are scared of going to the doctor. As a health professional, it is my duty to reassure them that everything is going to be just fine. When they have to undress in front of me, for me to examine, they are very vulnerable and I have to make sure they don't 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 to inflict discomfort and even pain to my little patients.

Indeed, my heart starts beating furiously and I have to remain apparently calm when a child undresses in front of me.

I always smile to myself when I see a little girl wearing long pants or jeans, along with a large sweater, probably thinking she is safe from exposing herself to me. But when the dreaded words reach her ears, to remove all of her clothes, the feeling of comfort just vanishes instantly from her mind.

A lot of the patients I see actually shake with fear when they are on the table, on their backs or tummies, completely naked. 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 my patients whenever I put on a pair.

As you would imagine, I never really have a problem in 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 child enjoys: the temperature taking. Of course, other pediatricians would take a child's temperature orally, under their armpit or their ear; but I don't believe in these methods. The most accurate way to take a child's temperature is rectally. Now, you have to know that I use a special kind of rectal thermometer. Unlike the small glass rod, the instrument I use is 7 inches long and has a diameter of 1 inch. No matter the age of the child, I use this thermometer, and I insert it at least five inches deep, for an optimal reading. Obviously, I am sure you can now see why the little ones don't like that part of the vitals check.

I now have to tell you about one of my favorite parts of a child's physical exam: the digital rectal exam (DRE). With one gloved hand, using my thumb, index and middle finger, I part the child'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 child's young age, the anal sphincter is extremely tight and the rectum's width can barely accept my fingers. The incredible tightness causes an exquisite warmth to reach into my fingers. Of course, with younger children, the digital rectal exam has to be performed slowly. But again, no matter the child's age, two fingers have to be inserted. The procedure can be painful for them, but it is necessary to assess a possible constipation as well the tonicity of the anal sphincter.

During the DRE, some children cry and protest. Some others, however, cannot keep still. In those cases, I need to restrain them. Of course, I could restrain them in non-humiliating positions. But I never do. My favorite position used to restrain a child is while they are on their back on the examination table. Using velcro restrains around their ankles, their legs are then brought up, perpendicularily to their body, with the help of a pully on the ceiling. Another set of restrains is used for their wrists, along their body, on both sides of the table 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 very thorough rectal exam. When the DRE is done, I proceed with a first visual exam of the rectum, using an anoscope. Rather short in lenght (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 strong 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 poor child on the table...

Often, to complement the basic 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 take very much delight in. The anal probe is a flexible instrument that is 30 inches long with a diameter of an inch. For the probe to be effective, it has to be inserted in its entirety in the child's intestines, through her rectum. The insertion is followed on a digital screen, with the help of which I can guide the probe through the intestinal curves. So you can imagine the discomfort of the little one when such a snake is inserted inside her! she can feel it quite distinctly moving up her tummy. Once, I had to use the probe three times on a six-year-old girl in the course of a week. She was terrified, screaming her lungs out when her mommy took her in my office for the following examinations...

Of course, to perform all these examinations, my patients must have a clean rectum and colon. In order to achieve this, several enemas are often needed for each one of them. Since they only are children, I exclusively use a double Bardex enema nozzle when an enema has to be given. The two balloons of the nozzle are perfect to force them to hold the solution in without causing any leakage. No matter the child's age, I never had a hard time to insert the first deflated balloon. Where the fun begins, however, is when I inflate that first balloon. First, the little girl is startled that something is growing inside her tiny rectum. But soon after, discomfort replaces the fear as the balloon expands more and more... Then, to complete the tableau, I inflate the second balloon, the one pressing outside, against her anus. The sight of the second inflated balloon, naturallly 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 girl stand by the exam table, her back to me, so I can admire her invaded bottom with the black pumps hanging down the back of her little legs. Of course, this is purely for my cruel pleasure...

Thanks to the Bardex nozzle, I make my little patients hold their enemas for long periods of time. I remember giving a nine-year-old girl a full three-quart enema bag, that she held for an impressive 40 minutes. The poor one had to be restrained, of course, as she would never have stayed in place. On an older girl of twelve, I managed to make her hold a three-quart soapy enema for 45 minutes, telling her that it was absolutely mandatory procedure. After twenty minutes, I could even hear the gurgling of the cramps she had started to get. She was not restrained, but was crying a great deal, without screaming.

The youngest patient I had to give an enema was a four-year-old girl. It was only two bulbs of a special mix of mineral oil to relief her from constipation. She was the only one on which I didn't use the Bardex nozzle. Instead, I used a small butt plug.

Oh, but I haven't looked at the time: I have to get prepared because I have a patient in 15 minutes! An adorable ten-year-old girl whom I saw three times already this past month. One of my favorite patients from the last year for sure. Probably the client with the strongest ano-rectal reluctance. The mere spreading of her cheeks without touching her anus is enough to make her shake and cry. I think I will have to start her examination with a three-finger DRE. Or perhaps four?